 S bye, którzy. Felly, dweud i'r 17 metw yn 2015 oedd y Cymru. Felly, dweud i'r Adam Ingram, MSP, sy'n ddau'r digon yn y Cymru a wedi gweld點u L�ffan i'n gweld Glwllawni Gweltydd. Felly, mae hi yn cyffredig eu ffordd i dysgu i ddael i'r cyffredig gyllideb yn rwynt mwy o'r ofyn interfere with the sound system, but also take the opportunity to remind people that committee members and our support are using tablet devices instead of hard copies of our papers. A first item on the agenda today is stage 2, day 2 of the mental health Scotland bill. Can I welcome the minister for sport, health improvement and mental health and his officials here with us again this week? For the record, I remind members that the minister's officials are here in a strictly supportive capacity. They can speak during the proceedings or be questioned by members. Everyone should have a copy of the bill as introduced, the second marshal list of amendments and the second grouping of amendments. There will be one debate on each group of amendments and I will call the member who lodged the first amendment in that group to speak to and move that amendment and speak to all other amendments in the group. I will then call the other members who have amendments in the group and then finally the member who lodged the first amendment in that group will be asked to wind up the debate and press or withdraw the amendment. Members who have not lodged amendments in the group who wish to speak should catch my attention in the usual way. If a member wishes to withdraw their amendment after it has been moved, I must check whether any member objects to it being withdrawn. If any member objects, the committee immediately moves to the vote on the amendment. If any member does not want to move their amendment when called, they should say not moved. Any other MSP can move it but I will not specifically invite them or the other members to do so. If no one moves it, I will call the next amendment. We now move to call amendment 48 in the name of the minister, already debated with amendment 47. The question is then that amendment 48 be agreed to, are we all agreed? Amendment 49, in the name of the minister, is already debated with amendment 47. The question is then that amendment 49 be agreed to, are we all agreed? I now call amendment 50, in the name of the minister, group with amendment 51. The minister to move amendment 50 and speak to both amendments in the group. Thank you, convener. In developing my position on the issues, my policy intention centres on the particular benefit from mothers and babies through maintaining and supporting this relationship in the first year of life. As part of that, it is important that our approach in this area is consistent with the Children and Young People's Scotland Act 2014, in recognising the rights of the child and promoting, supporting and safeguarding a child's wellbeing. Amendment 51 amends the 2003 act to provide that health board is required to provide services and accommodation only if it is satisfied that doing so would be beneficial to the wellbeing of the child. That would not preclude health boards from offering these services in other circumstances without being an express duty, where, for example, the impact on the child may be judged to be neutral. I believe that that strikes the right balance of requiring accommodation services are provided, where that is beneficial to the child, while providing flexibility for health boards to consider other circumstances. Amendment 50 is a technical amendment restructuring the 2003 act to accommodate the new provisions set out in amendment 51, in accordance with a move of amendment 50, in my name. I recognise that it is good and that it should be encouraged that mothers would have their babies with them, but I am just wondering if the catch-all that I am doing so would be beneficial to the wellbeing of the child could give health boards an opt-out. I am wondering when it would not be beneficial to the wellbeing of a child not to be with its mother. It seems to me that this is quite broad, but it seems to me that the situation where you would have a child away from its mother should be really narrow. I am a bit concerned, but the amendments may be very broadly drawn that would give health boards the opportunity to opt-out. For instance, if they did not think that the facility was right or they are like, what circumstances would you see that a parent and a child would be separated at that point? I think that the points that are made by Rodegrun are well made. I would observe that this bill already is improving circumstances for mothers who are right to have their children with them at the early stages. At the moment, in the 2003 act, I think that I am writing and recalling that it is only in circumstances where it is post-natal depression. Of course, we are widening that out, so it will cover other forms of mental health disorders. In that sense, we are taking on board some of the concerns about ensuring that we can make sure that children are with their mother where it is appropriate. Of course, the bottom line should be that it has to be appropriate for the circumstances of the child. I hear what Rodegrun is saying about the concerns about a health board interpreting the circumstances and not being appropriate because of the structure of the facility and so on. That is certainly not the intention. I am happy to look at whether we need to finesse this further, but I think that the principle set out here is the appropriate one and we should move forward with supporting this amendment at stage 2. We will look at that further in advance at stage 3, but my instinct is that that could of course be covered by the guidance that we issued, but it would of course not be the case that we want health boards to be interpreting it on the basis of the facilities. It is a duty that they would have to adhere to. The question is then that amendment 50 be agreed to. Are we all agreed? I call amendment 51, in the name of the minister. Are we ready to debate with amendment 50, minister, to move on? The question is then that amendment 51 be agreed to. Are we all agreed? The question is that section 23 be agreed to. Are we all agreed? I now call amendment 108, in the name of the net millon, already debated with amendment 103, the net millon, to move or not move? The question is then that section 24 be agreed to. Are we all agreed? I now call amendment 52, in the name of Bob Dorris, grouped with amendments 89, 90, 91 and 53. I point out that if amendment 52 is agreed to, you cannot call amendment 89 as preempted. Bob Dorris, to move amendment 52 and speak to all the amendments in the group. Thank you very much. Amendment 52 relates to section 25 of the bill, which I mean section 309 of the 2003 act, to allow regulations to be made applying some or all of part 16 of the 2003 act relating to medical treatment to patients who have absconded from jurisdictions outwith Scotland, while they are held pending removal to their home jurisdiction. That section would allow medical treatment to be given to those patients in accordance with those regulations. The purpose of amendment 52 is to amend a new section 309 so that instead of allowing regulations to be made applying some or all of part 16 to absconding patients, regulations may only apply to specific provisions of that part to such patients. The effect will be that the regulations will have to specify particular provisions of that part, which are to apply to such patients, so authorising only specified treatments to be given in accordance with the provisions of that part, rather than potentially applying to the part in its entirety. Amendment 53 relates to the regulation making powers introduced by section 25 of the bill, also amended by amendment 52. The purpose of amendment 53 is to introduce a new exception to the power to make regulations applying provisions of part 16 of the 2003 act to patients who have absconded to Scotland, so that the regulations may not authorise medical treatment of the types mentioned in section 234 or 2373 of the 2003 act. The effect will be that no regulations can be made without which would permit the giving of those treatments. That comes to the nub of both amendments. It would preclude treatments such as surgical operations and other treatments specified in regulations that were made under section 234 and electroconvuls of therapy to patients who have absconded from Scotland for other jurisdictions. It would explicitly preclude those forms of treatments with other forms of treatments to be outlined within regulations. I should say in closing, convener, that I worked with Sam H, looking at alternative amendments, but I gave consideration that alternative amendments may preclude routine treatment that may be necessary for on-going medication to be given. I hope that those two amendments provide the reassurances that are needed by stakeholder groups to protect the rights of absconding patients but still allow for essential treatment to be given when need be, and I hope that the committee will support amendments 52 and 53. I have listened very carefully to Bob Doris and I welcome the fact that he has moved amendments in the section. The amendments that I am proposing would go somewhat further than Mr Doris. What he is proposing is that certain treatments under part 16 would still be allowed subject to regulations, whereas what I am proposing is that all treatments under 243, that is all treatment other than emergency treatment, should be precluded. The bill that was originally proposed would have allowed ECT surgical operations intended to destroy brain tissue treatments to reduce sex drive and to force nutrition, whereas section 243, which is what I am proposing in my amendment, specifically authorises urgent treatment for the purposes of saving life or preventing serious deterioration, suffering or violent behaviour, so that there is a fairly broad area there that does protect the patients. The question really is to the minister whether, under regulations under part 16, those other treatments will be excluded because I think that they should be excluded unless they are there to save life or prevent serious deterioration. Certainly, the Government argued against the proposed amendment saying that it is not the Government's policy that more invasive treatments should be permitted in accordance with part 16, should be given to patients who have absconded to Scotland, but my amendment strengthens the situation, so I wait to hear the minister's reply and Mr Doris is summing up to see if we are getting guarantees on the regulations before I move or not move my amendments 89, 90 and 91. No other members. Thank you. I thank both Bob Doris and Dr Simpson for lodging their amendments. I know that a range of stakeholders have put a lot of interest in this area, such as the Scottish Association for Mental Health, as Mr Doris mentioned. As I said in the response to the stage 1 report, there has never been the Government's policy at certain treatments for which the 2003 act requires additional safeguards, as contained in part 16 would be given to patients who have absconded to Scotland. However, it is important that we strike the right balance in relation to allowing absconding patients to receive the treatment that they need. Dr Simpson's amendments 89, 90 and 91 would restrict treatment to urgent situations for the purpose of saving the patients' life, preventing serious deterioration and the patient's condition, alleviating serious suffering, preventing the patient from behaving, without there being a danger to the patient or to others. Although I recognise and understand the sentence, I think that those provisions extend too widely, as Dr Simpson said himself. They are fairly broadened. Bob Doris suggests that it could potentially restrict appropriate treatment for absconding patients, as it potentially does not allow for on-going or routine treatment that may be of benefit to the patient. As Bob Doris set out his amendments 52 and 53 and said to rule out certain treatments that require additional safeguards, electroconvulsive therapy, surgical operations and other treatments specified in regulations under section 234. Turning to Dr Simpson's question to me about what would be contained in the regulations, those amendments will allow detailed consultation before making regulations containing specific provisions relating to other treatment for absconding patients. My commitment to Dr Simpson and his committee is that that would be a genuine consultation. It is important that we undertake that to make sure that we get the right balance before we absolutely determine what would be in the regulations, but I think that the points that are made by Dr Simpson are well made. On balance, I believe that the amendments lodged by Bob Doris strike is the right balance in advance of that further consultation. I would ask the amendments to support amendments 52 and 53 and Dr Simpson not to move amendments 8, 9, 9 and 91. Bob Doris to wind up, presul of thought. Thank you, convener. I will just be very brief in my winding up here. I written down three words during the course of this short debate. It was proportionality, it was balance and it was safeguards, but it was safeguards for the patient in terms of when they will actually need treatment and when treatment should be included from being given to them. I think the amendments that I have put forward gives that balance on the basis that the minister has agreed today to have an open consultation in relation to what future regulations will be and I'm sure that that will be the case. I will carry on in proposing moving amendments 52 and 53. Thank you. The question is then that amendment 52 be agreed to. Are we all agreed? I now call amendment 90 in the name of Dr Richard Simpson. Already debated with amendment 52, Dr Richard Simpson to move or not move? Move. We then move to question, call amendment 91 in the name of Dr Richard Simpson. Already debated with amendment 52, Dr Richard Simpson to move or not move. I now move then to call amendment 53 in the name of Bob Doris. Already debated with amendment 52. Bob Doris to move. I move. The question is then that amendment 53 be agreed to. Are we all agreed? The question is then that section 25 be agreed to. Are we all agreed? I now call amendment 54 in the name of the minister and the group on its own. Minister to move and speak to the amendment. Thank you, convener. Section 26 of the bill is introduced amends section 136 of the 2003 act to provide that a prisoner may be transferred to hospital for treatment under transfer for treatment direction only where a mental health officer has agreed to us. A number of stakeholders, including the Mental Welfare Commission, Scottish Prison Service and Royal College of Psychiatrists did not believe that the requirement for mental health officer agreement should be mandatory in all cases, as that could lead to delays in transfer and treatment. In particular, the Royal College of Psychiatrists noted that it would be inequitable for an ill prisoner to have a delay in necessary urgent treatment because their need is to do with their mental health and not physical. Amendment 54 amends section 26 to allow a transfer for treatment direction to be made if it has been impracticable to obtain the agreement of a mental health officer. Appropriate guidance will be provided in the statutory code of practice to make clear that the presumption is that agreement should be received from a mental health officer before a transfer for treatment direction is made and that a mental health officer should be involved promptly after the transfer where that has not been possible beforehand. I believe that it maintains the right balance of requiring mental health officer involvement while avoiding any delays in treating it acutely unwell prisoners. I move amendment 54. I welcome this amendment because the practical situation is that we have a reduced number of mental health officers than we had 10 years ago, recruiting them is proving extremely difficult and therefore having an absolute requirement that a mental health officer should be involved in transfer from prison is actually going to be impracticable on a number of occasions. However, I think that this does need to be addressed because their engagement and involvement is important in both the short and long term. Getting that right is important, but my experience, having worked in a prison, was that trying to get a mental health officer was actually caused delays, which were not in the best interests of the prisoner or, indeed, other prisoners or, indeed, the prison staff themselves. I very much welcome this amendment. I wonder if the minister will be able to say that if in guidance there is a timeline in terms of ensuring that a mental health officer is involved after transfer. No other member? Well, thank you, convener. Let me thank Dr Simpson for his comments in response to Dennis Robertson's comment. Well, I suppose that no, there isn't because it hasn't been written yet, but we can certainly consider that in drafting the guidance. I suppose that we want to strike a balance between having a reasonable timescale, given the comments that have been made otherwise, but certainly something that we can consider. However, I think that the general principle for the reasons that Dr Simpson has set out is one that I would hope would be backed by this committee. Thanks minister. The question is then that amendment 54 be agreed to. Are we all agreed? The question is then that section 26 be agreed to. Are we all agreed? Thank you. I now call amendment 55 in the name of Dr Richard Simpson, group with amendment 56. Dr Richard Simpson, to move amendment 55 and speak to both amendments in the group. Thank you, convener. The issue of the inclusion of learning disabilities and indeed autistic spectrum disorder in mental health legislation was raised by a number of witnesses and in written submissions to the committee. Autism rights, psychiatric rights, Scotland called for the removal of people with learning disabilities and ASD from the mental health law. Inclusions Scotland commented that people with learning disabilities were concerned that they could be subject to compulsory treatment as a result of their learning disability alone. The committee received powerful testimony from Steve Robertson of People First, which questioned the appropriateness of the way in which people with learning disabilities were considered under the current mental health legislation. He said that we honestly believe that the time has come for a new piece of legislation that is just about people with learning disabilities. We think that it is only right and fair that learning disability is a properly defined as an intellectual impairment rather than a mental disorder. With that definition, we would want recognition that additional time to learn and support to understanding things together with easy read documents and support to make some decisions are what we need. We need those things to help us to take part in our communities rather than restrictions, detentions and efforts to keep us apart from the world that we want to live in. I recognise that the Government's keys to life document coming on top of the iconic and groundbreaking CME document produced under labour in 2000 does move things on for learning disability. We should recognise the fact that in 1999 recommendation 2 of the Milan commission was, in due course, the mental health and incapacity legislation should be consolidated into a single act. The McManus commission itself in 2009, i.e. six years ago, said that there was a need to review the 2000 incapacity act along with the 2003 mental health act. Northern Ireland has already begun this process of alignment of incapacity and mental health. I have raised in previous amendments my concern about the difference between stigma, i.e. significant impairment of decision making ability and capacity. This has to be looked at again. The alignment was echoed by a whole raft of witnesses who called for a wholesale review of mental health and incapacity legislation and gave further reasons to the committee because of new information on and knowledge about neurodevelopmental orders. I concur with the mental welfare commission who, in evidence to the committee, summarised the situation and I quote that, whilst the 2003 act and the adults within capacity Scotland act 2000 for their time genuinely led the world, there was now a need to start thinking about the next wave and particularly supported decision making and future plans. Those views are not just about this amendment but other amendments that I have raised, but by continuing to include learning disability and the definition of mental illness we are really harking back to a bygone era. The inclusion of learning disability as a mental illness goes to the heart of issues of capacity. The journey that we have seen from the lunacy acts of the 19th century when we had idiot schools to the asylum movement and the growth of the huge institutions such as RSNH, Gugbun and Lenox Castle, to the shift to the community, which happened in my professional lifetime, which was a really excellent move with transitional and double funding, to the groundbreaking CME report in 2003 and the 2013 report, which I have already mentioned of keys to life, must now or in the very near future be matched by and fully reflected in our laws. Colleagues, the simple truth is that, although those with learning disabilities are much more likely to have mental illness even than the one in four of the population generally, learning disability is not of and in itself a mental illness. To continue this definition, in my view, is an infringement of their human rights. Do they need protection in law, of course, but not in a law that can remove their human rights? Will a review be simple as the Government's second response, not their first one into the committee report, said that it would not be simple, but that it should not prevent us from immediately commencing with a review? In April 2014, the Committee on the Rights of Persons with Disabilities introduced a general comment on article 12 of the Committee on the Rights of Persons with Disabilities. In paragraph 38 of that general comment, it has stated that forced treatment by psychiatric and other health professionals denies the legal capacity of a person to choose medical treatment and is therefore a violation of article 12 of the convention. Learning disability is such a disability. It follows accordingly that state parties must abolish policies and legislative provisions that allow or perpetrate forced treatments. We cannot ignore the fact that there have been occasions when patients have been deprived of their right to refuse treatment when either they have not lacked capacity or the treatment and what is seen by those in power as being in the best interests of the patient may not, in fact, be so and that, if necessary, a speedy application to the court should occur where there is a dispute. The Government's response to our stage 1 report that it was not considering either removal of learning disability or autism spectrum disorder from the 2003 act nor a wider review, but more recently the Government's fuller response to it said that it was much more accommodating but still was saying that it would be difficult. I believe that the Minister is sympathetic and I would ask him today to make a firm commitment on the record to an early review and to discuss with other parties and with stakeholders the chair, the membership and remit for such a review in the near future. Amendment 56 goes further than mine in specifying that this must occur within a year. For me, a year is actually too long but, nevertheless, I would support Jackie Baillie's amendment if mine is not accepted or, indeed, if I do not move it. I will finish by saying on the 19th of May that the General Assembly of the Church of Scotland approved a report on human rights and mental health prepared by its Church and Society Council. That report strongly urged that there would be a wider review that I am calling for today. It also urged that the review should include the issues raised in the report, which included matters relating to legal capacity and consent to repeatment. Today, I am seeking this unequivocal commitment by the Minister for an early review with a full commission similar to the Milan Commission to examine the relevant acts, the 1995 criminal act, the 2000 incapacity act, the 2003 mental health act and the protection of vulnerable adults act. I will listen carefully to the minister's response before deciding to press my amendment because I do realise that my amendment might remove protections currently applying in the act to those individuals. Nevertheless, I believe that this is an important amendment that requires debate and discussion. Jackie Baillie to speak in amendment 56 and other amendments in the group. Thank you very much, convener. I thank the committee for allowing me the opportunity to move amendment 56. In doing so, I say at the outset that I am very supportive of amendment 55 in what it seeks to do, but I am conscious that it seeks to remove the definition of learning disability and autism from mental disorder currently within the bill's definition. Amendment 56, if you like, calls for a review in the event that amendment 55 is indeed lost, but amendment 56 is a reflection of discussions held by the cross-party group on learning disability and gives effect very much to their view, which was arrived at during quite lengthy discussions, which is that we wanted a review of the inclusion of those with learning disability under a definition of mental disorder. I absolutely acknowledge that unpicking complex legislation, much of it providing a passport to services and rights, is difficult to do, which is why amendment 56 is proportionate because it calls for a review. Let's face it, the review is nothing new. The Milan Committee first recommended this in 2001. The McManus review recommended this in 2009. Both supported the idea of removing learning disability from the definition of mental disorder from existing legislation. Call me a patient person, but 14 years on, it's still not happened. I think that it is time now to make that review happen. The amendment does not presuppose the outcome of any review. It simply ensures that the review will happen and we get a chance to look at complex issues away from the urgency, if you like, of the process of a bill and we can consider it properly. I hope that the minister can support this. I do like Richard Simpson to detect a change in tune and a more welcoming tune from the comments previously from the Scottish Government. We're indeed more negative, but I hope in moving amendment 56 that we will gain support from it from the Scottish Government. Thank you, convener. Any other members? Dennis Robertson. Thank you, convener. It's very brief. I have a great deal of sympathy for Dr Simpson's amendment and, to some extent, the very patient Jackie Baillie. Again, I probably just want to echo the sentiments, I think, from Dr Simpson and Jackie Baillie, that if the Government can provide us with the details as to when this review may take place, because I think it is something that the organisations, agencies that provide services for people with learning disabilities are asking for. So, again, I'm just echoing the sentiments from Dr Simpson and, again, I will listen to the minister's comments on that. No other members? Rhoda Grant. Just very briefly in support of those amendments, I think that we had very powerful evidence to the committee about the difficulties that this causes, and I think that it's time that we moved on and came to a better settlement for people with learning disabilities and, indeed, conditions that are not mental illnesses. I'll now move to the minister. I didn't see any bids from the member. Thank you, convener. I recognise very much the issues that Richard Simpson and Jackie Baillie have raised in their amendments, also the passion with which they argue their case. I have heard the concerns that a number of people and organisations have raised about the inclusion of learning disability or autism under the mental health legislation. For instance, I met with representatives of people first just last week, where this issue was discussed. The 2003 act provides people with learning disabilities and autistic spectrum disorders with important protections and safeguards and, importantly, access to care and treatment. Anything that we seek to do, we must ensure that those continue. In the Scottish Government response to the committee stage, one report that I indicated is our intention to carry out a review into the inclusion of learning disability and autism in the mental health legislation. It is important that we undertake that review to ensure that a whole range of views are heard, those who have been making the case that learning disability and autism should not be included and those who would make the case for the benefit of the protections, safeguards and access that legislation provides. We also need to consider very carefully the practicality and implications of any review that concludes learning disability and autistic spectrum disorders should be removed from the 2003 act. The review process would clearly allow for that turning first to Richard Simpson's amendment number 55. I do not support that amendment as it would remove the protections and safeguards that currently exist for people with learning disability and autism who are treated under the 2003 act and not replace them with anything in their place. Dr Simpson referred to the request for new legislation that is specifically related to the area of learning disability. Of course, his amendment would not achieve that legislation in and of itself. I urge Dr Simpson to withdraw his amendment in the light of the Government's commitment to carry out a review. Jackie Baillie's amendment 56 puts a requirement for ministers to carry out a review within a year of royal assent. I understand why she has done that. There has been an expectation that a review would take place over a considerable period of time. Indeed, since the 2003 act came into effect and again in the McManus report, looking at the specific timescale in Jackie Baillie's amendment, I note that Richard Simpson believes the period to be too long. I understand the sentiment. I would have observed that the timescale imposed by an amendment would mean carrying out the review at the same time as implementing this bill. The people who will need to be involved in implementation and feeding into secondary legislation developed the code of practice and putting in place the changes to services needed would also be key to carrying out a review. I want the review to be participative, to ensure that all voices have an opportunity to influence the process and to be heard, critically those with learning disabilities and autism spectrum disorder themselves. That takes time and sometimes can mean taking longer than expected for genuine reasons. As unexpected issues arise during the process, I do not want to set out an expectation, least of all in legislation that I do not think is achievable. I am making a commitment to carry out a review. I would be happy to speak to Jackie Baillie, Dr Simpson or any other member of the committee or Parliament in more detail about the issue. I would urge Jackie Baill not to press her amendment and, if she does, members do not support it. However, let me be clear that my position is unequivocal. I support a review of the inclusion of learning disability and autism in mental health legislation. I am happy to discuss that further with Opposition members and the committee. In setting out that position, I think that we have to be clear that we have to ensure that it is a genuine review. I do not want us to set up a timescale that could curb that from being a full-scale proper review. I welcome the fact that the minister has now committed to a review, although the time period is uncertain. As I indicated in my opening of 55, I think that this has to commence pretty rapidly. The carry-out is not the right word in Jackie Baillie's amendment. It seems to imply that it will be carried out and completed, but my interpretation of it is that the review would be at least commenced within a year. That is a reasonable expectation that the Government should, within months rather than a year, be establishing it. I am happy to withdraw my amendment because I raised it as a probing amendment in order to ensure that there would be a proper debate, which there has been. I realised that it would remove the certain protections from people with learning disability and that that would not be appropriate. I am happy not to move it, but, in withdrawing, I will support Jackie Baillie's amendment if she continues to press it on the basis that the review must be started within a reasonable period of time. We will, of course, have the opportunity at stage 3 to make minor modifications to ensure that it is about starting it rather than completing it, which is the implication of the minister's remarks. Walter Simpson is withdrawing. Is there no other member object? No. We will now call amendment 56 in the name of Jackie Baillie, which has already been debated with amendment 55. Jackie Baillie, to move or not move. Can I withdraw at the stage on the basis of a discussion with the minister about a firm timescale for review? I think that people's expectation is for that, but I reserve my right to bring it back at stage 3. Jackie Baillie, not moving. The question, therefore, is that we move to call amendment 109 in the name of Adam Ingram and a group on its own, Adam Ingram, to move and speak to amendment 109. This amendment was inspired by my constituent Fiona Sinclair of the Autism Rights Group. Fiona's research using freedom of information requests has established that there are no published statistics on deaths, suicides, adverse events such as assaults or restraints for the mental health system in Scotland. Indeed, there is no collation of any data for any of these categories, apart from deaths. There are statistics for suicides at a national level, but no separate collation of data for those in mental institutions or those subject to compulsory treatment under the Mental Health Act. Whilst there are pilot schemes now in place to collate some of this information, we obviously must, as parliamentarians, make sure that scrutiny is thorough and systemic. In addition, there appears to be little collation of evidence other than randomised control trials funded by the pharmaceutical industry on the efficacy and effectiveness of various drug treatments. It's impossible to judge how these compare relative to different forms of treatment. Amendment 109 would therefore assist the purposes of medical research, as well as providing a useful check on human rights within the system. I move amendment 109. I thank Adam Ingram for lodging his amendment. I think that it raises a very important issue on how we reduce harm to people who receive care and treatment and how information gathering can support that reduction. That is not just an issue in mental health services, but one across all health services. However, the importance of reducing harm to people who are subject to compulsory treatment is something I absolutely recognise. However, I do not think that amendment will deliver the improvements to services that it is intended to. I would argue that we have already put in place mechanisms to support improvements in patient safety in mental health services. Health boards already report deaths of patients who are detained in hospital to the mental welfare commission. The commissioner produced a report on 2014 death and detention, which provides an analysis. Healthcare Improvement Scotland runs a suicide reporting and learning system that shares learning from suicide reviews. I am sure that we will return to this when we debate Richard Simpson's amendment 110 on reviews of deaths and detention. In 2012, we introduced the Scottish patient safety programme in mental health. Just genuinely, innovative work in mental health services is run by Healthcare Improvement Scotland and involves all health boards that aim to systematically reduce harm experience by people who receive care from mental health services in Scotland. It is focused on five areas—communication at transition, leadership and culture, medicines management, restraint and seclusion, risk assessment and safety. Several of those are exactly those areas that Adam Ingram's amendment highlights medicines and restraint. The approach that is used in the Scottish patient safety programme is powerful because it allows services and front-line staff to focus resources, including in collecting and analysing information in the areas that need most attention locally and which will certainly change over time. Introducing a legislative requirement to always collect certain information or data would lack flexibility to do that effectively. I would argue that we have in place and continue to develop as a more effective way to improve safety and reduce harm to patients. I believe that that is more effective than introducing a new layer of statutory reporting information, collecting requirements that will have substantial resource implications for health boards and front-line staff. I would urge Adam Ingram not to press his amendment. Adam Ingram is trying to do—I think that it is absolutely essential that boards are collecting this information if they are going to learn. I hear what the minister says about the patient's safety programme, and of course that is very important. However, the fact that we do not have clear data on those issues is a matter for regret. It can be covered in regulations, and the Government should undertake that if the amendment is not supported. However, it is absolutely essential that we understand things appropriately. As I will indicate in my amendment 110, I think that the time has come for further reviews. Adam Ingram's amendment goes further because it deals with assaults, recorded adverse events and occasions in which restraints have been used in relation to a patient. Those are areas of concern by the public, and I think that it is important, therefore, that we understand so that we can see variations between health boards, which is something that I have gone on about considerably at length in this Parliament. That allows us to understand when one board is performing well and another is not. Unless we see that publicly and transparently, then we are not serving the public in the way that we should, despite all the excellent programmes that the Government has put in place. Adam Ingram, to wind up. Thank you very much, convener. I must say that, adding to what Dr Simpson said, I think that we need to improve the level of information that is available to us. A couple of years ago, we had the information commissioner producing a report criticising one health board with regard to its recording of significant adverse incidents, which was actually within the mental health services of that health board. There is a deficiency there in practice across the country. I would very much support Dr Simpson's suggestion that regulations should be used to ensure that practice across the country is improved. I hear what the minister is saying with regard to the level of bureaucracy that might be involved in the administration of this particular amendment, but I would certainly want to pursue the question of regulation. On that basis, I will withdraw my amendment, but I would certainly want to, perhaps in discussion with Dr Simpson and others, return to the issue if the minister is willing to listen to us. I would appreciate that. Members have withdrawn. I cannot speak on behalf of the minister, but his approach has been so. These days, I have taken evidence that has been very approachable and available to discuss in detail here, but the member has withdrawn at this point. Is there any other member objection? No, there isn't. I can now call amendment 110 in the name of Richard Simpson and a group on that so on. Dr Richard Simpson, to move and speak to amendment 110. That really follows from Adam Ingram's amendment. This particular amendment has been lifted and redrafted from Patricia Ferguson's private members' bill on fatal accident inquiries. The reason for tabling it here, instead, arose from the recent evidence session in the Justice Committee where the suggestion was made that the scrutiny of deaths in the mental health hospitals would more suitably fall within the mental health bill. At present, there are serious incident reviews, but correspondence that I have received personally from families are of the view that this is insufficiently regulated. My amendment will not prevent a fatal accident inquiry taking place if the procurator fiscal deems it appropriate. Furthermore, there are reasons to believe that notwithstanding any decision by the fiscal not to have a fatal accident inquiry, the health and safety executive should be conducting more investigations. Roger Livermore, with whom I have had considerable correspondence and who has extensive experience and expertise in this field, is scathing about the failure by the health and safety executive and indeed the ministers for failure to undertake detailed investigation. The situation is further confused by the role of the mental welfare commission. They also have a duty in this area and they have, from time to time, produced valuable reports proposing improvements. Finally, in respect of suicides, as the minister mentioned in the last amendment debate, those are part of reporting to the confidential inquiry into homicides and suicides. Colleagues, I believe that the fact that there are all these different organisations with part responsibility for the situation is unsatisfactory. This is a complicated and confused area which needs to be addressed. My amendment is moved, as is a later one on homicide, in the hope that it is either accepted in principle by the minister or in full. We do have need for clarity of process and for the families that we need transparency on those issues. The amendment as it stands will require the minister to establish a proper review of the arrangements for investigation of deaths. The amendment will also seek to involve stakeholders in the process. If the minister opposes this amendment in principle or supports it in principle but opposes the motion as it stands, I will probably seek to withdraw and reconstruct the amendment for tabling at a later stage, hopefully with the help of the Government. I do not see any other members. The minister, please. Thank you. Can I say to Ruth Simpson that the amendment is very helpful in raising this issue? I am aware from the mental welfare commission's report, death and detention monitoring that the most important issue that they identified was the higher death rate in general of individuals with a history of mental health admission. It was not compulsory treatment that is associated with death. It was the presence of mental illness, learning disability and related conditions. I have reflected on the issues that their report raises and on where the commission has identified that we should be ensuring that there is a more consistent and streamlined approach to reviewing deaths of patients in hospital. That approach should be focused on ensuring that services are able to learn from reviews that are carried out and improve services so that they are more effective and safer. The approach should also ensure that relatives or carers are able to participate fully in the process. I propose to ask the mental welfare commission in Healthcare Improvement Scotland to consider how a more effective and consistent approach to investigating deaths could be developed to expect them to take account of the views of relatives who have been affected by deaths in hospital. I propose to provide an update to this committee on those proposals that would allow for the committee to provide their views before we determine the action that will follow. On that basis, I would invite Dr Simpson to consider not pressing his amendment. Dr Simpson, to wind up. We are happy to withdraw on the basis of the minister's very helpful statement. Again, my concern would be the time frame on this, because if we do not see some fairly strong progress, I think that the concept of putting this at least into a requirement on ministers to produce regulations covering this, so we have absolute clarity, would be my preference at stage 3. On the basis of the minister's statement and further comments from the minister, which I hope we will see before stage 3, as to precisely how things are developing in discussions between the Mental Welfare Commission and Healthcare Improvement Scotland, I am happy to withdraw this amendment. Dr Richard Simpson is withdrawing, no other member object. No, the question is then that section 28 be agreed to, are we all agreed? Thank you. Now call amendment 57 in the name of the minister and a group on its own, minister to move and speak to amendment 57. To convener, section 57 of the Criminal Procedure Scotland Act 1995 sets out at subsection 2, the disposals available in cases where they accused has been acquitted on grounds of lack of criminal responsibility or where they accused has been found to be unfit for trial. Section 57A sets out equivalent provision for those who are convicted of an offence and who meet the test for a compulsion order and provides that a compulsive treatment may be made, authorising treatment either pursuanted, detention hospital or in the community. This amendment to section 57 is intent to clarify that a person who has been acquitted on grounds of lack of criminal responsibility or found to be unfit for trial may also be made subject to either a hostel-based or community-based compulsion order. I believe that it is appropriate that such a person should be able to be treated in the community in the same way as someone who has been convicted of an offence and an amendment achieves that intention. That is in keeping with the principles that act in terms of the least restrictive option and also allows the court to act on the recommendations of the psychiatrist and mental health officer preparing the reports for the court. The amendment also makes a consequential amendment to make clear the current position that a restriction order may only be made where a compulsion order authorising detention hostel is also made. I move amendment 57. Just a quick comment on this. I understand that this is under the bill on looking obviously at the person who is not fit to stand trial. I am wondering what consideration is made to the victim of a crime that has been committed where the person is not fit to stand trial to ensure that they do not suffer any detriment or, indeed, a repetition of the crime committed. I think that you will be aware of quite high-profile cases. I would observe, of course, that we are introducing a victim notification scheme through this very bill. We are, by virtue of the bill's provisions, putting in place an entire scheme for notifying victims of certain pieces of information that they otherwise may not presently be privy to or able to request. We are significantly advancing the rights of victims for the very reasons that Rhoda Grant sets out. That said, it is important that we ensure that we are treating those who are treated through the mental health system, rather than sent to the criminal justice system on an equal basis. That is what this amendment seeks to achieve, but the rights of victims are always going to be apparent. That is, of course, why we have legislated through this bill for a victim notification scheme. The question is, then, that amendment 57 be agreed to. Are we all agreed? I now call amendment 111 in the name of Dr Richard Simpson, a group on its own, Dr Richard Simpson, to move and speak to amendment 111. The effect of this amendment is to delete section 29, 4B and C. There is no provision that is made for cross-border transfers in the new section 52D of the Criminal Procedure Scotland Act 1995. Anticipate that the problems may be encountered with respect to female and child patients on remand who should be detained in high-secure facilities given that Scotland's state hospital does not have provision for female or child patients. Section 29, 4C allows the court to extend the assessment order for a period of 14 days. We note that the consultation to the first draft proposed extending the period to 21 days. Whilst we acknowledge that it is in the patient's interests that as full an assessment as possible is made, we do not support the increase from 7 days to 14 days. Articles 5 brackets 4 and 6 brackets 1 of the European Convention on Human Rights requires a timely hearing and we are not convinced that such an extension is necessary or proportionate. This amendment is supported by the Law Society. Does the committee have any other members? Thank you, convener. The amendment that Richard Simpson introduced is on an issue that is generated considerable debate during the passage of the bill. Indeed, when the proposals for the bill were consulted on the committee, I also highlighted the issue in its stage 1 report. As Dr Simpson referred to, our original proposal was to allow the court to extend an assessment order for a period of up to a maximum of 21 days rather than a maximum of 7 days, which is currently permitted under the 1995 act. The proposal generated a considerable comment, in response to the proposal, which would allow for a more robust and informed assessment. Not all of our respondents supported the proposal. We acknowledged that in reducing the period for an extension to a maximum of 14 days. The committee heard evidence at stage 1 from Dr John Crichton on the provisions extending the maximum period for the assessment order. He described that it will allow the clinical team enough time to fully assess patients in the most complex cases where more time is needed than is present available under the 2003 act to determine the patient meets treatability and other criteria set out in the act. Concern has been expressed that increasing the maximum period for which an extension may be granted from 7 to 14 days is or may be, contrary to the convention rights of a person being assessed, particularly the rights under article 5, which relates to the right to liberty and article 6, to a fair trial. Dr Simpson has just alluded to that. I suggest that those concerns proceed on a misunderstanding of how convention rights are secured in the context of an application for an extension of an assessment order. An extension can only be granted on application to the court and then only for the period in which the court permits subject to a maximum period in which the bill provides is to be 14 days. I would like to emphasise that this is a maximum period and the court can of course determine a shorter period than the full 14 days. When considering any application for extension, the court has to comply with the Human Rights Act 1998. It can only grant an extension if and to the extent that to do so is compatible with the assessed person's human rights. Therefore, the compatibility of any extension with the assessed person's human rights is assured not by the statutory maximum period established by the legislation but by the court's scrutiny of each individual case to ensure that the period of extension granted is no longer and is justified by the particular circumstances of that particular case. I emphasise that this extension may only be granted by the court on the basis of a report from the patient's responsible medical officer and will be done on the basis of clinical need. I ask Dr Simpson not to press this amendment and that, if he does move the amendment, the members do not vote for it. Dr Richard Simpson has wind-up presser withdrawal. I thank the minister for his response and I think that the fact that the court is going to determine this is really very important because that should protect the person's rights under the European Convention. On that basis, I will withdraw at this stage and consult with the Law Society as to whether we need to proceed at stage 3. No member objects to the withdrawal. No. The question is then that section 29 may agree to. Are we all agreed? The question is then that section 38 to 34 be agreed to. Are we all agreed? I now call amendment 58, in the name of the minister, group with amendment 59. Minister, to move amendment 58 and speak to both amendments in the group. Thank you convener. Amendment 58 extends the provision made in section 353 of the bill as introduced in section 353, in section 61A, to the Criminal Procedure Scotland Act 1995, in order to close a gap identified in that act. New section 61A will allow for the transfer of persons who are awaiting trial and are subject to certain orders, described as remand orders, to a hospital that is suitable for their needs. The amendment extends its provision to also cover patients who are subject to a temporary compulsion order. That will enable patients who are subject to temporary compulsion orders to be moved to a hospital more suited to their needs if it transpires that the hospital ordered by the court is unsuitable. That will ensure that such patients can be moved in the same way as patients on remand orders, that is assessment orders, treatment orders and interim compulsion orders. Amendment 59 provides for transfers of patients subject to assessment orders, treatment orders, interim compulsion orders and temporary compulsion orders to another hospital at any time during which the patient is subject to the order, not only within the first seven days of admission to hospital, as proposed in the bill as introduced. It is recognised that there may be situations where it does not become apparent until later that the hospital ordered by the court is not suitable, or indeed that the patient is in mental condition and therefore treatment needs might change over time, necessitating a transfer to a different hospital and therefore move amendment 58. Thank you. I do not see any members wishing to take part in the debate. Minister, any further comments? The question then is amendment 58 be agreed to. Are we all agreed? Thank you. I call amendment 59 in the name of the minister who is already debated with amendment 58. Minister to be informedly. Moved, convener. Thank you. The question is then that amendment 59 be agreed to. Are we all agreed? Thank you. The question therefore is that section 35 be agreed to. Are we all agreed? Thank you. I now call amendment 112 in the name of the minister who is already debated with amendment 93. Minister to be informedly. Moved, convener. Thank you. The question is then that amendment 112 be agreed to. Are we all agreed? Thanks. I now call amendment 61 in the name of the minister who is already debated with amendment 93. Minister to be informedly. Moved. Thank you. The question is then that amendment 61 be agreed to. Are we all agreed? Thank you. Thanks. I now call amendment 62 in the name of the minister who is already debated with amendment 93. Minister to be informedly. It moves, convener. The question therefore is that amendment 62 be agreed to. Are we all agreed? I now call amendment 63 in the name of the minister who is already debated with amendment 93. Minister to be informedly. Moved. Thank you. The question is then that amendment 63 be agreed to. Are we all agreed? Thank you. The question therefore is that section 39 be agreed to. Are we all agreed? Question is then that section 40 be agreed to. Are we all agreed? We now call amendment 92 in the name of Dr Richard Simpson and a group on its own, Dr Richard Simpson, to move and speak to amendment 92. The amendment has arisen from discussions with the 100 Families Organization, which is an organisation that supports families who have been affected by homicide involving individuals with mental illness. In the last 10 years, there have been 137 homicides committed in Scotland by those with mental illness, and only two have appeared to have been subject of published reports by the Mental Welfare Commission, and few appear to have been even the subject of adverse incident reviews by the boards. This may not be the case, but we do not know with any clarity what is available, as was discussed under amendment 109 in the name of Adam Ingram. This situation can be compared to England, where the figures are in the same period, 576 homicides, but 321 reviews occurred. While not perfect, those English reviews have suggested that it might be between 25 and 35 per cent of homicides that could have been prevented. Whilst the UK confidential inquiry in which Scotland participates is helpful, Scotland may not be adequately fulfilling its duty to the families of victims in requiring transparent reviews in every case, and those amendments seek to correct that feeling. The intention of those amendments is to provide, in primary legislation, clarity, consistency and accountability about reviewing and reporting on certain offences involving a person suffering from a mental illness, already known to services, as specified in 63A1. That would apply specifically to murder culpable homicide, and such other offences, as the minister may by regulation prescribe, as defined in 63A12. I would expect these other offences to include serious and violent assault and attempted murder. At present, colleagues, we have a dysfunctional system of reporting and review. It involves separate and largely unconnected decisions by multiple organisations. These range from the Procurator Fiscal deciding whether there should be an FAI, confidential inquiry reports that I have already mentioned into homicide and suicide, decisions by the health board whether to undertake a review, decisions by the Mental Welfare Commission whether they undertake a review and other organisations that may or may not have a role include the health and improvement Scotland, health and safety at work, especially where the victim is a member of staff and the offence occurred in a workplace and setting, and finally, of course, the minister him or herself could require a review. As I have said already, this issue came up because of concerns from the 100 families organisation, but for the record I want to make it clear that the number of murders, culpable homicides and serious assaults committed by persons with a mental illness are tiny in relation even to those with a severe and enduring mental illness. My purpose in moving these amendments is to ensure that under 63A2 that, if charged, the Procurator Fiscal will inform both the board and the Mental Welfare Commission, the board will then be obliged to make inquiries if that person has already been treated by the mental health services in that board or another board and then prepare a report for the commission. The purpose of these reports and the Mental Welfare Commission summaries, which I have also proposed, is to ensure that the board or indeed other boards learn from the incidents and amend procedures or practices to reduce the likelihood of a recurrence. The report must also be given to the victim if the victim is still alive or their families, although I gather that the amendment that is currently drafted does not actually ensure that it goes to the next of kin and that will need to be addressed at stage 3. Colleagues, this is not about blame, this is about improvement. It is also about protecting future persons with mental illnesses so that the procedures actually prevent them from committing these offences wherever possible. I am aware that there are two concerns about my proposals. Firstly, the timing as to how long ago should the mental health services have been involved to require them to conduct an inquiry and produce a report, but since those are likely to mainly involve persons with severe and enduring mental illness, I do not propose that there should be a time limit. If there was no follow-up in the cases where there is a severe and enduring mental illness, this may in itself be actually the problem that the boards may need to face. Secondly, there are discussions on going, I know, as the minister has already mentioned in relation to a previous amendment, between the Mental Welfare Commission, Health Improvement Scotland and the health boards. Now, this is of course welcome, but will the outcome be enshrined in law or regulations? Will the outcome include all the points that I have made? I believe, colleagues, victims and their families, and indeed those with a mental illness, as well as society, are best served by having this in primary legislation. I move amendment 92 in my name. Thank you, convener. I know that Dr Simpson is taking a considerable interest in this issue and has been working closely with victims organisations. I want to thank him for that work. I believe that it is important. Indeed, it is imperative that the voices of victims and their representative organisations are heard. I understand that he has also met the Mental Welfare Commission to hear about the work that they are proposing to undertake with Health Care Improvement Scotland. I have considered the advice that the commission has provided about how we can improve reporting of homicide, and I agree that we should improve it, convener. The commission is therefore seeking a more streamlined system that ensures that lessons are learned and shared across the system, which provides comfort and reassurance to families in these tragic cases. The commission already has a power under section 11 of the 2003 act to investigate cases of deficiency of care. It has from time to time investigated homicides by patients under this power. The commission has proposed that they, working with Health Care Improvement Scotland and the Scottish Government, should build on this to ensure that all cases are reviewed appropriately. In some cases, this would involve a review initiated by the local health board with oversight of the commission. In cases where there are serious concerns about the provision of care or reason to believe that significant opportunities to prevent a serious incident where mist the commission could conduct its own investigation, it would also be possible for a fatal accident to be held where this is appropriate. The commission is working with Health Care Improvement Scotland to refine the proposal, which they hope can be brought into effect soon. I would propose to reflect on their proposal and, if it were helpful, to write to the committee to update members on that in due course. I have some concerns about whether an amendment was drafted would achieve what is intended. The provision triggers the need for inquiry upon a person being charged with an offence prior, therefore, to conviction that a person charged may be acquitted because they are not guilty or found not criminally responsible for conduct constituting offence by reason of mental disorder. Having an inquiry at this early stage would seem to cut across the criminal justice process and may be thought to be inappropriate a stage prior to final disposal of the case. The publication of reports also potentially raises issues about confidentiality, especially cases where a person is acquitted. A publication about sensitive personal details relating to mental health would not normally be made public. It is not clear how confidentiality is to be safeguarded. In light of those concerns and more significantly of the work already under way, I would urge Dr Simpson not to press his amendment. I begin by saying that I very much welcome this part of the bill in general, that the whole approach of trying to involve victims and their families in the process has been extremely welcome. I also welcome the fact that there is on-going work between the Mental Welfare Commission and Health Improvement Scotland to try and streamline the system. I do have some residual concerns that I do not think are necessarily being addressed, though I remain to be to see if that is the case. The health board itself does not deem the incident to be a sufficient problem to pursue an investigation or a review, but the victim or the families feel that that is necessary. There must be a mechanism beyond going to the Mental Welfare Commission of ensuring that, at an early stage, health boards are required if the victim or the families raise an issue of concern that a review should be held. I am not convinced that we do not need primary legislation, but I accept that the issues around charging and confidentiality that the minister raised are important issues. On that basis, I will withdraw the amendment as it stands, consult with those with whom I have been discussing, to see if a further amendment should be made at stage 3. However, that might depend on fuller information from the minister, which he has already offered to keep us up to date on, occurring before stage 3, to at least give us an outline of where we are going if I would fully understand that full regulations cannot be delivered. However, if we get an outline of the principles involved, that would probably be sufficient for us not to have to require this in primary legislation, but I will reserve my position. No other member object. No. We now move to call amendment 113, in the name of Dr Richard Simpson and the group on its own, Dr Richard Simpson, to move and speak to amendment 113. This amendment arises from discussions with the faculty of forensic psychiatry, and I should declare my interest in the sense that I am a fellow of the Royal College of Psychiatry. The very first piece of legislation passed by the new Scottish Parliament in 1999, a legislation in which I was personally involved, was to tackle the situation arising from an appeal made under the European Convention on Human Rights by Noel Ruddell against his detention in the state hospital of Carstairs following serious offences. That arose because ECHR was incorporated into Scottish law. The Mental Health, Public Safety and Appeal Scotland Act 1999 introduced the serious harm test. That made patients convicted on indictment or complaint and subject to special restrictions by the court, subject to indefinite hospital detention if a mental disorder was present and they were considered to pose a risk of serious harm to the public irrespective of the appropriateness of the order or the treatability of the subject. The legislative provisions of the 1999 act were subsequently extended to the Mental Health Care and Treatment Act 2003 to apply to all restricted patients in Scotland, numbering about 250. There remained a small number of patients who became stuck within the forensic mental health system because of its provisions, who had subsequently been reclassified as personality disorder. If that information regarding their mental disorder was known at the time of the sentence in all likelihood, they would not have been subject to a mental health disposal. The Court of Criminal Appeal subsequently recognised in the case of Alexander Reid that the change of diagnostic category could be considered as new evidence and allowed for a new disposal in the case of Mr Alexander Reid. However, the process for raising his appeal took several years. As an alternative approach to the problem raised by cases such as no rattle is that there should be some mechanism by which the appropriateness of the sentence could be reconsidered in patients whose diagnostic category has changed and whose detention in psychiatric hospital is consequently inappropriate. The whole approach in Scotland to personality disorder defenders was considered by an expert group entitled Services for People with Personality Disorder, chaired by Professor Thomson, which reported in 2005. The report of the working group, published in May 2005, recommended that the Scottish Government should consider whether a mechanism should be created to refer such cases to the Scottish Criminal Cases Review Commission for consideration. That position was re-articulated in 2011 when the forensic network gave evidence to the commission and women offenders, chaired by the right hon. Dame Elish Angiolini. The amendment 113 seeks to create a mechanism whereby patients whose diagnostic category has changed following sentence to have the appropriateness of that sentence reconsidered in the light of the current or revised diagnosis. Typically, this amendment will affect those restrictive patients who, having been admitted on a mental illness diagnosis or a learning disability diagnosis, are subsequently recategorised as having a personality disorder and then find themselves stuck within the mental health system with their detention continuing to be justified on the basis of their personality disorder and the risk of the harm that they pose. The Faculty of Forensic Psychiatry believes that such individuals with personality problems are far better supported and managed within the prison system rather than the mental health system. That will allow individuals in future similar to Alexander Reid to have a mechanism for the courts to review their disposal. The current system is extremely cumbersome and costly and not in the best interests either of the patient nor society nor indeed the victims. The amendment allows for the mental health tribunal for Scotland to review the appropriateness of the mental health disposal following a review of a compulsion order without restrictions. If the tribunal considers that the on-going compulsion order is inappropriate, given the clarity of the situation and bearing in mind the interests of justice and the principles of the act, it may make reference to the appeal comport to reconsider the sentence. The amendment would be likely to apply to only a small number of individuals seeking to obtain a more appropriate disposal from the court. Finally, the benefit of the amendment would be that, even if that small number of patients currently stuck within the system were transferred to the prison service, it would be saving the national health service of something in the region of £200,000 per patient. I move the amendment in my name. I do not see any other member who is going to take part in the meeting minister. Thank you, convener. Dr Simpson's amendment opens up very complex issues in proposing new powers for the tribunal courts that would revisit the decision of the court and its original sentencing and disposal. It also opens up what can be very complex, competing clinical opinions about diagnosis. I understand this amendment to be designed to address concerns among some psychiatrists that patients who are diagnosed are indeed misdiagnosed as having a mental illness or learning disability. I mean, subject to compulsion order or compulsion order and restriction order on that basis may lead to, in fact, be diagnosed as having a personality disorder, which had the court had full medical evidence based on that diagnosis, may have resulted in a prison sentence rather than a mental health disposal. Yet once in the hospital system and because the patient continues to satisfy the test for a compulsion order or compulsion order and restriction order due to the risk of serious harm that they pose, they cannot be released. It appears to me that this proposal would result in a significant shift in how mentally disordered persons are dealt with by the criminal justice system and indeed by the health service after conviction. The present position of the 2003 act is quite clearly that a patient who meets the conditions for a mental health disposal and request to be detained may in many cases most appropriately be detained in a hostel rather than in prison. The 2003 act provides that mental disorder includes personality disorder, so it is possible for a patient who has a personality disorder with no co-occurring mental illness to be detained in a hospital. A more fundamental change to the 2003 act definition of mental disorder would be required to prevent that. An amendment to the criminal procedure of Scotland in 1995 extended the time period for an interim compulsion order from six months to 12 months to ensure that a full and rigorous assessment of the offender's mental disorder is undertaken before the final disposal is made. It is very unlikely that an offender would be misdiagnosed in those circumstances, so it is very much less likely that a patient would now receive a hospital disposal from the court that would recreate this scenario now. All patients subject compulsion orders and restriction orders have the right to apply to the tribunal and for the orders to be reviewed periodically. In addition, there is already a means for the patient to have their case considered on appeal. The same appeal route is used for those offenders who receive a prison sentence, who argue that they should have received a hospital disposal. The amendment is, I recognise, well-intentioned. However, it is a major issue, and given the implications for the criminal justice system, it is not one that I believe we should be sensibly considering without thorough consultation. I would urge Dr Simpson on that basis not to press his amendment, but if he does, I would strongly urge members not to vote for the amendment. Dr Simpson, to wind up, please withdraw. I think that the numbers involved and affected by my amendment would be very small. The minister has almost conceded that in the statement that he has made just now. I agree with him that, normally, a period of six to twelve months might seem long enough to ensure that there is not misdiagnosis, but in practice there will be still a small number of individuals affected. Detention, then, in the state hospital for them is inappropriate, and they will wish to be transferred to the prison. At the moment, as is clear from the Alexander Reed case, the present situation is one that is cumbersome, and indeed costly, in terms of the legal requirements to get this changed by the court. I am concerned that the reports that were made by Professor Thompson in 2005 and that the evidence that was submitted to the Angelini Committee in 2011 indicates that this is not a new problem that has just arisen in 2015, on which we are considering today. This is yet another area in which there has been an extensive period in which the Government has had the opportunity to consider matters and come to a conclusion. I will not press my amendment at this point in time, but I will reserve the right to have further discussions with the faculty of forensic psychiatry and to look at bringing this amendment back at stage 3, unless, of course, the Government wishes to consider introducing an amendment, or at stage 3 giving a guarantee that the wider review to which they have committed will include a review of this particular area so that we can resolve the situation, thus saving the individual's concern being continued to be detained for a more extensive period within the state hospital, which is not good for them, and also in order to ensure that the limited resources of forensic psychiatrists are appropriately applied and more appropriately applied to those who actually are going to benefit from that, rather than having to continue to be applied to those detained inappropriately in the state hospital. I hope that the minister will consider some of what I have said. In withdrawing, we will see if we come back at stage 3. Thank you. Thank you. We will throw in any other member object. No. Therefore, amendment 64, in the name of the minister, is already debated with amendment 1. Minister to move on now. Moved, convener. Thank you. The question is then that amendment 64 be agreed to. Are we all agreed? The question is then that section 41 be agreed to. Are we all agreed? Thank you. I now call amendment 65, in the name of the minister and a group on its own. Minister to move and speak to amendment 65. Thank you, convener. This amendment deals with an issue highlighted by the Mental Welfare Commission and released to the revocation of a restriction order. Part 10 of the 2003 act contains provisions in relation to compulsion orders and restriction orders. There are various provisions that allow for applications or references to be made to the mental health movement. The tribunal considers that it is necessary for a compulsion order and restriction order patient to remain subject to a compulsion order, but the restriction order is no longer necessary. It must make an order under section 193 revoking the restriction order. Section 196 provides that the revocation does not take effect until the occurrence of certain events, including the expiry of the appeal period and the determination of any appeal lodged against the tribunal. Section 198 provides that, from the day in which the tribunal makes the revocation order, the patient is treated as being subject to compulsion order, according to the day in which the revocation order is made, the patient is subject to various review requirements. That means that, from the day of the tribunal hearing, the patient must be treated as though they were a compulsion order patient, even if the tribunal's revocation of the restriction order has not yet taken effect. That could lead to the registered medical officer being required to carry out the review of the compulsion order, in spite of the patient continuing to be subject to a compulsion order and restriction order. Amendment 65 ensures that the provision works as it should. It has the effect that a patient whose restriction order is revoked should not be treated as being subject to a relevant compulsion order within the meaning given by section 1371 of the 2003 act and its attendant review requirements until such time as the revocation takes effect. Thank you, minister. No member is wishing to speak. No. Minister, I do not want to add any. No. The question is then that amendment 65 be agreed to. Are we all agreed? Thank you. The question is then that section 43 be agreed to. Are we all agreed? Thank you. I now call amendment 114, in the name of Dr Richard Simpson, group with amendment 115 and 116. I now call amendment 114, in the name of Dr Richard Simpson, group with amendment 115 and 116. Dr Richard Simpson, to move amendment 114 and speak to all amendments in the group. Those amendments follow discussions with the Law Society and the aim is simply for simplification and clarity. In the new 16A, as it is currently proposed, the statutory language is somewhat cumbersome in the view of the Law Society. Amendment 114 will have the effect of deleting reference to subsection 2 as a qualification of section 1. Amendment 115 adds to the end of section 1 a new subsection 4e and 116 deletes sections 2, 3 and 4 in the original bill, as proposed. The effect of all those amendments is that we are left with a fully modified section 441 subsections A to E, which the Law Society believes will be simpler and clearer. I move amendment 114, in the name of Dr Simpson, as he has set out intent to improve the clarity of the text that is to be inserted as a new section 16A of the 2003 Criminal Justice Act. It seeks to do this by taking three separate sentences and collapsing them into a single very long sentence. Personally, I do not think that that makes the proposed new section clearer. I think that it achieves the opposite of the choice between saying something one way or another that comes down in large part to personal taste, but legislation is carefully prepared. Just moving words around in the statutory language can change the legal effect, and that is the case with those amendments. The first point is that the amendment changes the emphasis and that in turn changes how readily victims' rights to information arise. Under the bill, the default position is that information is to be given to a victim where the criteria in subsection 1 are met. That right can only be applied in exceptional circumstances. The amendment unduly changes the emphasis by requiring exceptional circumstances to be ruled out before any entitlement to information ever arises. The second problem with the amendments is that they would leave subsection 4 out of the proposed section 16A altogether. I am not clear why that has been proposed. Subsection 4 is clearly important because it states when a victim's right to information about a patient comes to an end. As I do not think, amendments 1 to 4 to 116 make proposed section 16A clearer, and more important because they would change the proposed section's effect in unintended but unhelpful ways. I would suggest to Dr Simpson that he does not press him, but if he does, I urge members to vote against him. I hear what the minister says, and I will go back and have further discussion with the Law Society, but I will not press this amendment at this time. Dr Simpson is withdrawn, no other member object. I now call amendment 115 in the name of Dr Richard Simpson. He is already debated with amendment 114. Dr Simpson, do not move. I then call amendment 116 in the name of Dr Richard Simpson. He is already debated with amendment 114. I then call on amendments 120 in the name of the minister group with amendments 121, 122, 123, 124 and 125. Minister to move amendment 120 and speak to all amendments in the group. Those amendments are all to part 3 of the bill that provides for victims of mentally disordered offenders to introduce the statutory notification and representation scheme for victims of mentally disordered offenders who are subject to certain orders. The intention is to develop a scheme as close as possible that resembles the scheme that is available to victims under the Criminal Justice Act 2003. In proposing those amendments, I have considered the work that the forensic network of victims rights and victims of mentally disordered offenders guidance short-life group. The group includes representatives from the NHS, social work, victim support Scotland, hundreds of families, the mental health tribunal, Police Scotland and the Scottish Prison Service for the Expertise in Operating the Victim Notification Scheme under the Criminal Justice Act. I have also taken into the committee's view set out in the stage 1 report that the scheme should not discriminate against mentally disordered offenders. Those amendments reflect that concern and intend to ensure that victims have rights to information and make representations in a way that as closely as possible reflects the provisions for victims under the Criminal Justice Act. Amendment 120 clarifies the information that will be relayed to victims when the mental health tribunal direct conditional discharge under their powers in section 1937 of the Mental Health Act 2003 or when Scottish ministers varied the conditions of discharge under section 202 of the 2003 act, which gives Scottish ministers powers to recall a patient who has been conditionally discharged from hospital. The effect of the amendment is that any information being provided about any conditions that have been made, imposing restrictions on the things that a patient may do after his or her conditional discharge. In practice, there will commonly be restrictions as to where the patient is prohibited from going and persons with whom the patient may not have contact. Amendments 121 and 122, along with the whole approach to developing the victim notification scheme, has been proposed to mirror the criminal scheme as closely as possible so that victims of crimes have as comparable rights as possible. The policy in which we are trying to achieve is a proportionate position to ensure that the victim has information that is pertinent to them, in this case to know that patient's rehabilitation has reached the point where they will be unescorted in the community. Those amendments will mean that a victim will be entitled to make representations on the first occasion that a decision has been made about granting the patient unescorted suspension of detention. The approach taken to granting unescorted suspension of detention is usually planned and, depending on the patient's progress, that plan can be updated on multiple occasions during a year, ranging from very minor changes to larger ones where the patient progresses more quickly. It would be disproportionate for victims to be provided the opportunity to make representations in each occasion on a escorted suspension of detention that is granted. It would also potentially impede a patient's rehabilitation. I think that that achieves the right balance. Amendment 121 relates to offenders subject to hospital directions. Amendment 122 relates to cases where offenders are subject to compulsion order and restriction order. Amendment 123 means that victims will provide representations to ministers when writing has been proposed to mirror the position of taking the criminal justice scheme in line with the approach to the victim notification scheme as a whole. Amendment 124 provides for the situation where a patient who is conditionally discharged is recalled to hospital by ministers. Amendment means that the victims will have the right to make representations when a decision is being taken to grant unescorted suspension of detention for the first time after the patient is recalled. Amendment 125 is intended to clarify how the tribunal will take into account representations that victims make when taking a decision about granting conditional discharge of a patient. The tribunal will be required to take into account the victim's representations when considering what conditions to include when granting conditional discharge. That is intended to include conditions that would directly affect the victim, such as an exclusion zone that the patient cannot or a condition of no contact. Victims might make representations of how a decision might affect the victim or members of the victim's family and move amendment 120. That is just very briefly, convener. I understand that the purpose of the amendments being moved, putting in inserting for the first time. I do have some slight concerns about that, in that there may be, for example, unescorted, for a very brief period, and that it may then be followed by a much longer period of unescorted, say, weekend leave or whatever, and making it just for the first time if that is correct. If it is just for the first time, it seems to me to be a little restrictive and that it may be that the minister might explain whether, if there was a process of rehabilitation that a longer period of unescorted leave would be notified, if that was deemed to be appropriate in the victim's interest rather than leaving it just for the first time, which I think is, if I understand it, overly restrictive. Thank you, convener. I suppose that the first thing to observe, of course, is that this is a new mechanism. That is not a reduction in rights for victims. Of course, that is creating the rights in the first instance. I think that we should also make clear that victims' organisations as representatives have not been lobbying for the right to representation on each occasion. Of course, we constituted a working group to come up with those proposals, and that group critically included victims' organisations, Victim Support Scotland and 100 Families, an organisation that Dr Simpson mentioned earlier, when he has been working with. I suppose that it is just about striking a balance. I think that it is proportionate that, in the first instance, victims should have the right of representation rather than being required on multiple occasions. I would also observe that that could be considered to be an onerous requirement on victims themselves. They may not, in every circumstance, welcome such a mechanism. Of course, I make the point that we want to reflect the victims' rights process that is in existence for the criminal justice system as closely as possible. That is the right to set out there, so it is about trying to treat people on an equal basis. I think that it is about trying to strike that balance. I think that the proposal, which is informed by representatives of victims' organisations, is the correct way forward. I urge the committee to support the amendment. The question is then that amendment 120 be agreed to. Are we all agreed? Question is then that section 44 be agreed to. Are we all agreed? Thank you. Can I now call amendments 1 to 1, 1 to 2, 1 to 3, all in the name of the minister, all previously debated. I invite the minister to move amendments 1 to 1, 2, 1, 2, 3 on block. Ask whether you should move them first. I will do, convener, if you let me. Move to convener. Any member object to a single question be put on the amendments 1, 2, 1 to 1, 2, 3? No. The question therefore is then that amendments 1, 2, 1 to 1, 2, 3 are agreed. Are we all agreed? And the question is that section 45 be agreed to. Are we all agreed? Question is that section 46 be agreed to. Are we all agreed? Thank you. You can hear that tone in my voice that, you know, I've got witnesses waiting, and we're trying to get through this. I call amendment 124 in the name of the minister, already debated with amendment 120. Minister, can you move forward? Move quickly, convener. Thank you. The question is then that amendment 124 be agreed to. Are we all agreed? Thank you. Question is then that section 47 be agreed to. Are we all agreed? Question is then that section 48 be agreed to. Are we all agreed? Thank you. I now call amendment 117 in the name of Dr Richard Simpson and a group on its own, Dr Richard Simpson, to move and speak to amendment 117. This is an amendment to section 49, the effect of which to be to ensure that recorded matters under section 64 of the Mental Health Care and Treatment Scotland Act 2003 are included in the orders that the tribunal may make when confirming the determining or vetting a compulsion order. Section 64A of the Mental Health Care and Treatment Scotland Act 2003 sets out the definition of recorded matter. The tribunal can specify a recorded matter when making a compulsory treatment order and also when reviewing a compulsory treatment order. In essence, a recorded matter is regarded as an essential element of the patient's care and treatment. If a recorded matter is not provided, the registered medical officer must refer the matter to the tribunal under section 96. This reflects the Milan principle of reciprocity. Recorded matters are a means for ensuring that the patients get the essential elements of the care and treatment that they require and can be used to secure care and treatment that might not otherwise be provided. This is a significant benefit to some patients. Currently, recorded matters can only be specified in compulsory treatment cases. They cannot be specified in cases where the treatment is under a compulsion order or a compulsion order under restriction order. The view of the Law Society is that such patients would benefit from the inclusion of recorded matter provisions. Compulsory treatment orders are civil orders, whereas compulsion orders and compulsion orders and restriction orders are criminal justice orders. All patients should have the right to obtain the essential treatment that they require, regardless of their route into the mental health care and treatment scheme. I move the amendment to my name. I thank Dr Simpson for introducing his amendment. I have considered the case that exists for introducing provisions for the tribunal to specify a recorded matter in cases where the patient is under a compulsion order or a compulsion order or a restriction order. I am confident that the existing provision of the 2003 act worked well for patients subject to compulsion order or a compulsion restriction order. However, I am happy to consider whether there are improvements that could be achieved by extending the use of recorded matters to those covered by such orders. However, I am unclear as to why an amendment is for section 49 of the bill. Section 49 is in part 3, and part 3 is exclusively about victims' rights as per its title. Section 49 contains amendments in connection with victim notification only. Section 49 is not particularly suitable for use for unrelated topics, whether involving the 2003 act or otherwise. The amendment is not related to victim notification. In my view, it is therefore confusing to put it in part 3. It seems to me that the amendment should be to part 1 of the bill, as part 1 makes a large number of amendments to the 2003 act for a wide variety of topics, apart from victim notification. I would also note that the amendment on its own does not appear to do what is intended to do and should perhaps have been accompanied by other consequential amendments. I should say to Dr Simpson that I would be very willing to work with him to try to bring forward an amendment on amendments at stage 3 that could better achieve the aims that are set out in his amendment 117. On that basis, I would ask Dr Simpson not to press his amendment. No further comments and withdraw. No member object. No, thank you. We now move to call amendment 125 in the name of the minister to move on. The amendment was suggested by the Law Society to deal with an omission as they see it from the 2003 act, of which section 320 provides a route of appeal to a sheriff principal against certain decisions of the tribunal, which can be brought by both the individual concerned and a number of relevant parties defined in subsection 5. Those included name persons, a guardian of the person, a welfare attorney, the mental health officer or that person's responsible medical officer. However, this fairly comprehensive list admits to mention a person's curator at lightham where one is in place. Curators at lightham are people appointed by the court to people who lack the appropriate capacity to instruct a lawyer. In the case of Brian Black's curator at lightham to the patient against mental health tribunal for Scotland and the Scottish ministers in 2011, the inner house of the court of session found that curators at lightham didn't have the statutory right of appeal to a decision by the tribunal. The Black case did point to the power of curators at lightham to bring judicial review against a tribunal decision, but, of course, that is quite a different mechanism to an appeal and requires a virtually complete alienation of reasonableness in a public authority's choices before its decision can be overturned. That would appear to be a fairly straightforward omission, which leaves these often vulnerable people without an effect of legal remedy against decisions of the tribunal. That puts these individuals at a considerable disadvantage and one that I don't believe is either a justifiable or was intended in the drafting of the 2003 act. I move amendment 118. Thank you. Any other members wish to participate? No, go directly to the minister. Thank you, convener. This is an important issue and one that I think is linked to the debate that we had last week about the appointment of named persons. The members' proposals highlight concerns as to the ability of patients who lack capacity to instruct their own legal representation to exercise rights of appeal under the 2003 act. This amendment would allow a curator appointed to represent the patient at tribunal or before the sheriff principal a right of appeal in those circumstances. Currently, section 3202 of the 2003 act titles a relevant party to appeal to the sheriff principal against the decision. A relevant party includes the person to whom the decision relates, that person's named person, any guardian of the person, any welfare attorney of the person, the mental health officer and that person's responsible medical officer. It's not the case that the patient does not have effective remedies under the act. In my amendments on named persons, I move amendment 43, which has been agreed to provide for a listed person to exercise rights to make an application or appeal where the patient has no named person and does not have capacity to initiate the application or appeal. A listed person is defined as any guardian of welfare attorney of the patient's primary relative of any and the patient's nearest relative. A listed person would be able to initiate an appeal under sections 320 to 322. My view is that the provisions of the 2003 act and the bill being considered ensure that patients without capacity are not disadvantaged. However, I am willing to consider the merits of the principal provisions set out in Annette Milne's amendment 118. However, with amendment 117, among clear wise, the amendment is for section 49 of the bill. I said previously that section 49 is in part 3. Part 3 is exclusively about victims' rights and I am not sure that it is suitable for this amendment. It seems to me that the amendment should be to part 1 of the bill, as part 1 makes, as I said previously, a large number of amendments to the 2003 act for a wide variety of topics, apart from victim notification. On that basis, I urge Annette Milne not to press her amendment and for us to discuss the matter in advance of stage 3. If Ms Milne does press her amendment, our members are not to support it. On the basis of what the minister has said, I will draw the amendment at this point of time. Thank you. The member is withdrawn and no other member objected. The question is then that section 49 be agreed to or will be agreed to. I call now amendment 119, the name of Annette Milne and a group on its own, Annette Milne to move and speak to amendment 119. This amendment makes provision for practitioner psychologists to be considered alongside medical practitioners for the purpose of the 2003 act, allowing them to take on the statutory roles of approved medical practitioner and responsible medical officer. As members will be aware, this follows extensive representations from the British psychological society. At present, only medical doctors are registered as AMPs and only consultant psychiatrists perform duties as RMOs. The proposals for a greater role for psychologists aim to reflect that the primary treatment for a number of mental health problems is psychological. In many situations, a psychologist may be the best-placed professional and the one most familiar with a particular patient's case. The situation is already quite different in England and Wales since equivalent roles were opened up to practitioner psychologists under the provisions for the mental health act in 2007. The same high standards of learning and familiarity with mental health law are expected of all approved clinicians in England and Wales. The change has widely been seen as a success. Practitioner psychologists are already recognised as having the skills to supervise people under the criminal procedure set out in section 135 of the 2003 act. There are a number of vulnerable individuals for whom psychological therapies are particularly relevant—people who have learning disabilities, people on the autistic spectrum, people with personality disorders and people with eating disorders. The contention is that the most appropriate person to undertake AMPs and RMOs in those cases will be the person most familiar with their treatment and care and that there will be a positive impact on patients' rights from this measure. While that is a significant change, we can point to England and Wales as an example of a similar system adopting those changes and there is evidence and see evidence of how they have operated in practice. If the Scottish Government were mindful to conduct further investigation and consultation on the proposed change, there would be plenty of opportunity for this to be done after its inclusion in the bill. It will require further action from ministers to put those provisions into effect and have psychologists registered as AMPs and RMOs. The British Psychological Society has said that they do not expect uptake from psychologists to be high in the initial years, but that change now will lay the groundwork for it to become far more commonplace in the future. I move amendment 19. Thank you. Any other members who wish to participate? Richard Simpson. I know that the College of Psychiatry, my own college, is not in favour of this amendment, but I think that their view is somewhat old-fashioned. This is occurring in England, and it will not apply to the totality of practitioner psychologists. We should achieve a mechanism whereby there can be approved practitioners from psychology who should be able to support their colleagues in dealing with a limited number of cases where they will have the primary role. I think that the view of the college in this instance is old-fashioned. I was personally engaged in the 1980s in ensuring that all patients referred to psychologists no longer had to go through psychiatrists, which at that time was the case. The position of the college in this matter is out of date. This is a helpful amendment, and it may require regulations specifically to determine which practitioner psychologist should be allowed to do this, but it would be helpful to have the extension. It would also be helpful to understand how this has worked in England, which, at the moment, I do not have any information on, but it would be useful to know that. If it has worked well, the time has come for us to adopt a similar approach. Thank you, convener. I will be brief. I think that there is a role for psychologists here. I would like to ask the minister, if he is mindful, to meet with Nanette Milne and others on the committee to discuss this further and how we can move this perhaps to include psychologists, but I will not be supporting the amendment at this stage. However, I would be mindful and I would hope that the minister would agree to meet to see how we can progress this. It is an important matter. No other member? Minister? Oh, sorry, Mike Mackenzie. I would really just add my support to the comments made by my colleague Dennis Robertson. Thank you, convener. I also thank Nanette Milne for introducing her amendment. I met representatives from the British Psychological Society who set out their proposals on the specific role that psychologists play in the care and treatment of people under the provisions of the 2003 act. They highlighted in particularly often pivotal role that they can play in caring treatment for people with learning disabilities and within forensic mental health services. I am sure that we all value and appreciate the work that psychologists do in that regard. Considering this amendment, I recognise that mental health services are delivered by multi-disciplinary teams and those teams will be in different locations and in caring for different patients. The legislation sets out a wide range of duties for medical practitioners. I do not think that it is prudent to make that change without proper consultation. The British Psychological Society has made a case for the role that psychologists could bring to some of the duties under the 2003 act. I would want to see the case for how that would work in practice and what that means for all those duties. I would also want to understand how the roles of the different professions that make up multi-disciplinary teams can be used to undertake the role that is set out in the act to effectively best support patients. I am concerned that any changes that the Parliament makes to the legislation can be implemented sensibly. As draft amendment would extend all duties of medical practitioners to practitioner psychologists, I am not sure that that is what is intended. Rather, it is something more specific that identifies exactly which duties the practitioner psychologist or indeed another clinician should be able to undertake. I want to understand what those duties are and how that would be implemented. I am also unclear as to why the amendment appears to be for the general provisions in part 4 of the bill. Although the new section for the bill containing the amendment is headed interpretation, the provision is not even for the interpretation of the bill. It is rather for the insertion of material into section 329 of the 2003 act for the interpretation of the provisions of the 2003 act. Indeed, it would affect the legal and practical operation of the 2003 act. As a whole, it seems to me again that the amendment belongs more properly in part 1 of the bill, as part 1 makes, as I have said before, a large number of amendments to the 2003 act for a wide variety of topics. In addition, the amendment does not merely deal with some formal matter of labelling or interpretation. It deals with the crucially important issue of who has to be regarded as a medical practitioner in the context of the 2003 act. I would also suggest that it is unhelpful to the reader of the bill to put this under the innocuous heading interpretation at all, as it conceals the true range and nature of the change to the operation of the 2003 act. I do not support the amendment because it does not think that there is merit in considering the duties that professions other than doctors could undertake, rather because it needs proper consideration and consultation before changing the legislation. The bill intends to make technical changes to operation of the act, the light of the McManus review. I appreciate that there is a desire to take the opportunity to make other changes, but I believe that we should try and keep the bill fairly focused and consider other changes. Due course, I have already indicated the Government's intention and willingness to look at the inclusion of those with autistic spectrum disorder or limbic disability in mental health legislation. I am also very willing for us to consider this issue of the role of psychologists in mental health legislation 2, but only on the basis of being fully and properly informed. Dennis Robinson made a request that I discuss this with anyone who wants to discuss it with me. Of course, I am happy to do that, but I would urge the net mill not to press this amendment at this stage, and if she does urge members not to vote for it. On the basis that the minister has indicated his willingness to have further discussions of what I actually think is a very important subject and I think it does need progressing at some point, but at this stage I would be willing to withdraw the amendment. Members withdrawn? Any member object? No. The question is then that section 50 be agreed to or are we all agreed? Thank you. The question therefore is that section 51 be agreed to or are we all agreed? Thanks. The question is that the long title be agreed to or are we all agreed? We are all agreed. That is in stage 2 consideration of the bill. Just before a suspend to change over, we previously discussed agenda item number 2. It is actually confirmed that we move directly further to suspension to agenda item number 3 in order that we do not layer witnesses any further today. Can I have the committee's agreement? Suspend momentarily. Thank you minister and your officials. We now move to agenda item number 3, which is the first of our two panels today. Firstly, apologies for the delay so far. It was important that we got that stage 2 finished. Until now, our oral evidence has been mainly focused on the carers. Today it is the turn of local authorities and health services on the panel. We welcome to the committee councillor David O'Neill, president and Beth Hall, policy manager, health and social care Scotland. Welcome to you. Paul Henderson, service manager, per city, mental health, drug and alcohol, Perth and Caross Council. Penny Noel, joint planning and commissioning manager and carers strategy lead officer, Dumfries and Galloway Council. Allison Jarvis, community nursing programme manager, NHS Lothian. Welcome to you all this morning and we're going to go directly to questions and Annette Millan is going to ask her first question this morning. I'm going to look at the issue of eligibility criteria because a key feature of the evidence we've heard so far from carers is the issue of whether eligibility criteria for support should be set locally or nationally. The carer organisations very strongly believe that if there's some, only if there's some element of these criteria set nationally, will there be equity and certainty for carers. Many of them pointed situation with social care more generally where eligibility thresholds have been raised over the years as resources have become more constrained and they are concerned that resources will simply be focused on crisis care to the detriment of preventative support. Now I'm aware that COSLA and it's written evidence to pretty the opposite view from that and that should be focused very much on sort of local setting of criteria and I think there was some variation between the councils. So I just wondered what the panel thoughts are. Do they have sympathy with the views of the carer organisations? Do you think that they'll get equity if criteria are set locally and basically could you deal with that issue for us? Thank you. I have sympathy with the view that's been expressed and I understand why carers would think that way but we have lots of evidence that shows that the closer you take decisions to the service shoes or the closer you take decisions to the community that they're aimed at, the better outcomes you get. Now if we set out in legislation what the criteria is to be, that will reduce the amount of flexibility, it will reduce innovation, it will reduce the ability to deal with individuals on an individual basis. What we're looking at is a client base here, a people who are very diverse with very different needs, very different aspirations to have one set of eligibility across the whole of Scotland will not serve them well. I do understand where they're coming from and there should be a focus on outcomes, the outcome that we want to achieve for these individuals. That's a perfectly legitimate thing to do but I think it would be counterproductive if we were to try and get a one-size-fits-all approach across every community in every individual in Scotland. In which to respond to that? I would agree with that. Just in terms of a local democracy point of view that councils should be able to set their own criteria for that. We find that we're already making allowances for carers and particularly in terms of a preventative approach and you wouldn't want to create a criteria that would miss out on that preventative approach. That's based on a locality model point of view where you are listening to the needs of local carers so it would be a fear that that would drive that away and create just one criteria. I can see the argument both ways. I understand what people are saying but I also feel that although variation is good, sometimes it's important to have some degree of consistency so I can be persuaded both ways. I understand where the carers organisations are coming from and I can understand where the costers are coming from. Maybe just to pick up on Alison's point and some of the other contributors. In terms of the need for consistency I can understand the concern there but I think there's also a way to address that through being consistently transparent about how eligibility has been approached. Within the context of finite resources and demand that will always outstrip the resource available there has to be some way of deciding who gets what. There has to be some way of prioritising and targeting resources and I think that needs to be done locally because demand varies not just from council to council but within council area and also over time it's constantly fluctuating and councils need to be able to adjust eligibility criteria. The local level is a means to managing that demand and as David said that is the way that you will get the best fit between demand and provision. It's the best way to ensure that resources are being used flexibly to meet outcomes. I think that trying to do that at a national level is a much blunter tool and doesn't represent the best way to get the most flexibility and the best outcomes for carers individually. I'm a bit like Alison and my colleagues here that I feel that I can see the carers point of view and the carers argument but fully endorse what my colleagues have also said about councils needing the flexibility. John Fries and Galloway is a very rural region and so we need to be able to flex to take into account that that rurality and particularly in some of the parts of the region we have a lot of people retiring to the region who don't have the family connections and so on and so we need to be able to find ways to support those carers in other ways and depending on priority of need really. I can see both parts of the argument as well. I personally do think that decisions are often better made at as local a level as possible in all not just in this field but in lots of fields however I do understand the concerns of the cliched postcode lottery which I think quite a lot of carers have raised and they are particularly concerned about that. My sense is that a lot of organisations in the last few years a lot of authorities and health boards in the last few years because of the the national carers strategy and implementing that and carers information strategy. Speaking for Dumfries and Galloway there's quite a lot of services that are accessible to all carers and I can envisage those remaining so information and support from generic and some specific conditions for carers such as dementia and mental health and so on but the generic support is definitely region wide as well so and that won't change. Paul Henders. I just want to agree with that. I mean in terms of just the practical practical point of view of supporting more older people in the community for longer we are just in necessity having to support more carers as well so you know whether from a value point of view but also just practically in order to support more people in the community we are having to do that already and address the needs of carers in a more preventative way because they are the people that are keeping people in the community for longer in the majority of cases so we are anyway necessarily I think going down that route. David, do you want to come back? To just a final point share we've been going down the road of self-directed care for this last while if we do something which specifies for a particular part of the service users that we're trying to provide for that kind of contradicts what we're doing with self-directed care give the people the flexibility to give them the decision making power. I think that there's a couple of supplementary questions on this particular area so I saw Dennis Robertson involved. Do you? Thank you convener. I want to just pick up this aspect of the flexibility because my understanding is that if we have that national criteria there will be some flexibility in trying to ensure that we do cover areas like Dumfries and Galloway for instance or my own constituency in Aberdeenshire West. My problem is that if you have the local aspect and having worked in social care for over 30 years I am aware of the restriction of resources and if you're looking at outcomes and we looked at prevention my concern is that you raise the bar too high because that is what's been happening in local authorities for years because when the needs get greater and you're suggesting the resources are less in terms of meeting those demands then you raise the bar and if you raise the bar too high then the people will not get a service so I think we need to have some degree of assurance that we are providing a level playing field across all authorities to ensure that we are meeting the demands of the carers. Allegibility criteria have been used to manage diminishing resources I suppose I think that's what we're picking up from some areas you know whether that can be. I understand where people are coming from with that I mean we have right now we have support for carers which operates according to local needs you set a set of nationally agreed criteria then some people are going to get a lesser service than they are currently getting. The local authority in conjunction with the service users have been able to design a service which is suitable for them you get national criteria you might have to impose something which is less suitable but I suppose it is. No that is not nonsense I'm not having heckling Dennis even from you. No no I mean I mean I was following up on my question. No no there was there was a wee chow there we're not we're not having that. There are other people wanting this as well and I think Bob wants in, I think Mike wants in, Rhoda wants in so if you want to ask a follow-up question well let's have a response from the panel. Now David you respond does anyone else wish you to respond? Just going on the last point I made in terms of just a preventative approach because I mean we are now supporting people that you could say fall out our community care eligibility criteria because we recognise that we don't put preventative services and now we'll end up having more crisis support later and I think particularly in terms of the carers supporting carers that that is one of the key factors because if we don't put in the support now what we're finding is it's coming as crisis support and it's ending up in more costly services for us. Beth. I think maybe just to come back on the national criteria and where you set the bar I think if you have a national eligibility criteria that guarantees that needs above a moderate level or whatever will be met for carers as demand increases across other social care groups you will need to shift resource from there in order to maintain this absolute bar around one particular group around carers and I think that's maybe what David was trying to highlight that within the context of finite resources if you protect it at that end it's got to come from somewhere as demand increases and I think that just relates back to the point that I was making earlier about demand fluctuating and they need to be able to respond to that because let's face it we are all dealing with a situation where there's finite resources. Bob. Oh sorry thank you community care as we're going to get in so earlier that's good. I'm just wondering if there's a conflation over eligibility criteria and resource provided locally and I'm sure it's not deliberate so nationally for example in terms of providing a bus service for young people in secondary schools if you stay three miles away from that secondary school so primary schools you have to get a bus pass some local authorities decide to do that at two miles and there's a cost implication to that I'm just wondering the the panel's view that you could have nationally set consulted on with COSLA and other local authorities and stakeholders over national eligibility criteria about carers who should have a service provided at least have a service provided and then local authorities should they choose to can have that local prioritisation to give added value to that and local discretion I'm getting the resistance about any direction at all from the centre and as MSPs here we get postcode lottery thrown at us all the time so we expect national standards and things such as who does or doesn't pay prescription charges no one pays it that's a nationally set thing we don't say that goes against local democracy because one part of the country can't decide whether or not to to charge prescription charges so I'm just wondering in the perspective of nationally set and consulted on eligibility criteria as to who would qualify for support not what that support would be but it would be a permissive power to local authorities to go further if they wish because the people that I represent and I get the financial pressures that local authorities are under the carers that I represent will see a a defensive approach from the witnesses here this morning so in the spirit of the way my questions being asked in terms of certain key benchmarks that nationally we all agree carers irrespective of whether it's urban or rural and not saying what the localised manifestation of that support is but can you at least concede perhaps we should consider some form of national eligibility criteria but then a permissive power for local authorities to go further if they wish we're not saying what the service you have to deliver is just the fact that there has to be some kind of gateway mechanism to make sure carers irrespective of where they are in the country get a degree of service chair my understanding of the proposed legislation is that it is a duty it is descriptive even to the extent that it's got what would normally be included in guidance being included in the face of the bill it is there for removing flexibility is designing a service which is one size fits all we don't think that's a particularly good way to go for individuals you have to design these services to suit the individual you can I have a one size if there was to be legislation which prescribed what the outcomes the strategic outcomes were to be that's absolutely fine there's absolutely nothing wrong with that but as I understand it the way the legislation currently is the bill currently is it's prescriptive yep if anyone wants to add for that Beth you want yep I mean we just to to expand a bit I mean I think that there is a bigger issue here about democratic accountability for for use of resources and in terms of the comparator to prescription charges for example prescription charges are not dealt with at the local level social care is is the responsibility of local authorities and local authorities have to be democratically accountable for the resources that they they invest in social care and part of that accountability and responsibility means coming up with a way to decide who gets what when there's a finite amount of resource and if you're picking up a theme there around that needing to happen at the local level that's probably what's underpinning it is that social care is is the responsibility of local authorities so sorry I'm just repeating myself now I think that the other issue there is that if you have if you move away from that model of democratic accountability for for the use of the resources setting aside what that means for councils for the moment for other groups of people who are using social care services it means you have a situation where one group has entitlement defined nationally yet another group it's defined locally so so there's an issue there for us as well and sorry I'll try and be brief but maybe just moving on I think it would be useful to be clear about what what we're talking about here and when we talk about eligibility we can be talking about an eligibility framework that consists of eligibility criteria and eligibility thresholds and I think there are two different things and this distinction is quite important and as much as I think criteria is about how you categorise needs and that needs to be transparent and that's about perhaps your same we categorise it into critical substantial moderate that's one thing and in a sense we already have that operating at the national level and as much as we have national eligibility criteria that can be used and bring that degree of transparency when I talk about thresholds that's about deciding at what level those needs will call for the provision of services and I think from a local authority perspective it's very important those two differences it's eligibility and thresholds that we are saying need to be set locally and I think within the bill itself it's not entirely clear what is meant when the term eligibility criteria is used and because we would understand that to mean the the latter how you categorise needs and not thresholds where you decide where someone's eligible for a service so I think there's quite a lot in there so if our responses are kind of showing both sides or or maybe not that clear I think I think it's because of some of that Paul and Benny I just want to to follow on what Beth said because I don't want it to appear defensive at all I think we were very supportive towards towards carers and I wish to support them more I think it is that that distinction about what what is meant by an eligibility criteria for example with this national eligibility criteria for adult adult care around councils but within that councils can set the thresholds for that it's our permissibility to set the threshold I guess is would be the issue for us and not been fixed that this is exactly what we've got to provide and this is a national thing that that local accountability be able to set your own thresholds Penny? Yes again I'm sorry if we appear defensive but the reality is that we are struggling at within social work departments to to balance the books at the end of the day and deliver ranges of services to very diverse meet very diverse needs but another element of all of that I've spent a lot of time trying to model out what are we what kind of costs are we looking at and and that in itself I know that's that's taking it further on from eligibility criteria but it's it's really really challenging because at the moment even in a relatively small authority like Dumfries and Galloway we don't actually know all of the carers who have identified themselves as as carers in the last census and we don't think that that's relevant either we're not it's not it's not relevant we don't think that's accurate either because we know that through other means we can identify that there's more carers and so if we don't even know those figures it's then hard to model that out and to come to some kind of idea about the kind of figures we would be looking at. I wouldn't reply to that I think that's a separate question I wasn't in a supplementary as the convener pointed out I'd just like to thank in particular Ms Ollor, Mr Henderson for giving her a bit of light and shade to the discussion around national eligibility criteria and the bill does say may not must but I think there's more discussion should have on what that would look like and I thank the convener for letting me have the supplementary on that. Okay, Rhoda. Then to the financial aspects of this which seems to be an issue about how you gauge criteria in COSLA submission they pointed out that the financial memorandum used the figure of 300 pounds for a short break while the average cost they felt was closer to 967. Given that some of the figures used and obviously this will range depending on where about in the country people live that has to be taken into account given that we're not sure how many carers there will be that will be eligible and given that we're not very sure about the costs that are to be accrued has there been any work done by councils throughout the country as to what the costs are because surely some of those services are being already provided to carers in different areas so there must be an idea of costs and use of things like the census and indeed some of the other work and I think as well the bill looks at not everyone being covered immediately which concerns me as well but percentages of carers being covered going forward so this will be an incremental increase in costs rather than one day one every carer must be covered. I'm wondering if any work has been done to look at realistic costs and where that maybe falls short and what we need to do, what maybe work the committee needs to do when examining the bill. I think we have been working with our members and asking them for information around costs. We've shared that with Scottish Government who have obviously looked at that along with their data colleagues and I think as you'll have picked up from costless submission we're not in agreement with the figures in the financial memorandum and I think that is for three main reasons. We don't agree with the unit cost of assessment that's presented and we're concerned that about the speed at which carers may come forward following announcement of the new duties and we're also concerned about the total numbers coming forward. In looking at firstly the unit cost of assessment we had initially had discussions with Government and we're happy with a figure that had been arrived at which took information that we'd got from councils, removed the outliers, looked at what your average cost was going to be and that came out at 176 per assessment. However, what appeared in the financial memorandum did not present 176 as the midpoint, it presented it as the top point and put in some other costs below that. I think that we're concerned that that's not the realistic reflection of where we thought we were in our understanding about costs. You also spoke about within the bill carers not being covered immediately in the sense that the duties of the bill would apply across all 759,000 of Scotland's carers from day one. All carers would be covered immediately and I think where we then are in the business of trying to figure out how many people would come forward, you know, of those 759,000 would come forward and how quickly. I think that it's very difficult, our response, our submission to the finance committee recognises that, but what we did do is look at other areas of service provision where you have a universal entitlement. This bill will introduce a universal entitlement to a carer's assessment. Of course, not all people will uptake it, but it is a universal entitlement. If you look at how demand is built for, for example, free personal and nursing care, it was much sharper rise than is profiled within the financial memorandum. It profiles at very low and slow. If you also look to England, who have introduced similar legislation, it's too early to, you know, that's only just come into force. For example, they had to revisit their impact assessment, their version of a financial memorandum twice and revise the figures up the way for carers assessment. That would indicate that it's coming through quicker down there. What we're saying is that there's quite a lot of risk here in terms of demand potentially outstripping the resource that's made available if more come forward or they come forward more quickly. At the moment, all of that risk is lined with local authorities and with carers themselves in a sense that they'll have increased expectations of what can be delivered for this. You asked in terms of the committee doing further work. Where we are at in terms of doing further work is that we've asked the Government to revisit the figures and agree a model for estimating costs with us. We can't be certain, we just want to agree a model and agree to monitor the true costs of implementation and for Scottish Government to fund any excess requirement if demand does exceed it. I think that that's a more appropriate sharing of risk, but so far we've been unable to secure agreement to all of that. Sorry, that was quite a long answer, but I think that there are many unknowns and it is a difficult area. Are there any other responses, Pam? Yes, thanks. Just to add on and to answer your question, yes, we have in Dumfries and Galloway tried to model out some of the costs. We did an initial basic version when we were responding to the COSLA questionnaire back in January and then I've revisited that a number of times since. I was discussing this with my colleagues in the third sector and they looked at me and said, yes, but you've forgotten to take in the fact that we haven't got the capacity within the third sector at the moment. That's a really significant issue to be taking on board because clearly whilst we welcome the growth of the third sector in supporting us to go deliver support to carers, they obviously have their processes and so on to go through first. That's something that needs to be taken into consideration as well. In Perthgros, we've done some financial modelling based on the stats that we've got. Our unit cost for completing a carers assessment came out at £215, which is much higher than the high-level costs that it's presented. We just based that practically on how long we asked the social workers how long it took to complete a carers assessment, they said, between a day and a half. That's what we basically based on, a salary of social workers based on that. We've got concerns within the carers that we know are registered carers and we've got approximately £3,600. We know from the census in 2011 that there are 13,000 people identified themselves as carers and we've extrapolated from that what we would need if everyone needed a carer support plan. We worked out, probably cost around another £200,000 that we would need for that. We have been working on that in terms of the actual care costs, in terms of providing respite or replacement care, although it's quite difficult to get a sense of what that would be. The bit more concerned about is the waving of charges and what interpretation is given around the waving of charges and whether that includes some form of respite care, whether you start looking at day care as a form of respite. That's been one of our concerns around that area, but maybe that's going off the subject a bit. I was taking that, that was a supplementary flowing from the eligibility criteria, so if you can leave it at that, I want to get Mike in. The only one question that I would like to ask then in terms of those calculations about costs, has been any calculation about the benefits of proactive engagement with carers or the preventive benefits that might flow from earlier engagement with those carers who don't require anything at this time, but clearly carrying out a caring role? There hasn't been a kind of cost benefit analysis for what that would look like, but certainly in our plans, in terms of information and advice and early support, we think that that preventative support would stop further crisis later on, so we haven't actually worked on an amount for that, but we know that that is something that we need to do, so we support that element in terms of information and support and advice. If we can get that early, that would support that, but we haven't done any actual calculations without alleviate. Yes, just as a kind of back of the envelope kind of how many carers do we have in Dumfries and Galloway, knowing the sort of numbers of carers that we have caring for more than 50 hours and so on and so forth, and it was an amazing number of carers that are being delivered every week, and it turned into millions of carers per year, a staggering figure, and if you translated that into a basic unit cost of £18 an hour or £10 an hour or whatever, it still is a huge amount of money, so that's the amount of money that's being saved in terms of health and social care provision having to go in, so there's no doubt about it. We all see carers as an absolutely vital element of working in partnership with carers in going forward in the delivery of health and social care into the future. I think, not particularly picking up on your point, but some of the discussion around preventative care, that is something that comes up time and time again, not just with patient groups around long-term conditions and things, but also with carers, that desire to feel that there are small interventions that are put in that can make a big difference, and I think that's always the concern with the focus on either the high end of caring or all the discussion around eligibility criteria. We miss the opportunity for preventative interventions, whether that's a health intervention or whether that's a social care intervention, and I think we shouldn't be underestimating them if we're thinking about all the sort of push towards preventive and anticipatory care. We have to be investing at these relatively low levels because I think that will make a big difference. Just one final point is that quite often I've found that carers, if they've got the knowledge that there's support available, they don't access it. At one point in my life, I was a carers support worker and trying to encourage carers to come to support groups, it was for mental health. I used to bump into people, in fact I think I used to meet more people in Tescos than I met at the carers support groups because people were like, oh yes, but I'll come along when I need to, I'm sure you need to support somebody else who's got a greater level of the need than I have at the moment. People did really feel that safety net was really important for them. Cosly, do you have any work on that in terms of the possible benefits of the bill about early intervention or prevention? I think in common with Paul, what we haven't done is I consider a piece of work at a national level that looks at the actual financial benefits of outcomes. It's quite a complicated thing to do in a robust way. You're into looking at social return on investment models and such like, but all the work that underpinned the joint carers strategy and the joint young carers strategy very much took that as a starting point in terms of looking at how could you maximise more preventative approaches in the knowledge that that will take demand out of the system later on and is better for everyone. I think that those two pieces of work and also some of the work that was done around the change fund, if you remember the part of the change fund, was to be used for improving support and services to carers. That was very much again on the premise that it was about shifting the balance of care and looking at much earlier interventions. Did you achieve that with the change fund? Was that another case where the money was used to just meet the current demand rather than that preventive aspect? I haven't brought figures and things on the change fund with me today, but I know that there was a focus on looking at what that money went on and reporting around it. That's in the public domain, so I'm sorry that I can't give you a summary read-out today, but the information is available. It's always difficult to cost something that hasn't happened. I think that that's a problem with a lot of these sort of all these preventative things to cost something that hasn't happened, whether it's that someone didn't go into hospital or that their hospital length of stay was shorter or whether there wasn't a complaint or whatever. A lot of certainly in terms of some of the things that were spent with the change fund, a lot of it was things that didn't happen in a positive way, but to cost that and to show the benefit or even to prove it, I think that it's always a huge challenge. What we estimated that most of the support that we provide to carers isn't actually discreetly provided for carers, it's actually provided for the service user or the client, whether that's usually some form of daycare or any form of support for the client, invariably benefits the carer as well. In most cases, we estimate that we spend approximately £800,000 on carers specifically, but we know that we support carers in many other ways, up to about £40 million from our different day carers and so forth. It's actually quite hard to say that this is particularly for the carer and that this is for the service user or the client and that's what made some of the financial modelling figures that we were doing for the cost of submission quite difficult because we had to try and extrapolate bits from that because certainly the amount that we spend for carers discreetly is not all that we're providing for carers. I'm really interested in discussing about the finances around the bill and I think that Alison Jarvis was talking about innovation and eligibility criteria irrespective of where that's at and how it's at, that process, not squeezing out innovation and using money more cleverly. A lot of carers, just one section of carer community of course, is those looking after elderly loved ones and health and social care integration boards at the forefront now. I know that it's not specific to the bill but I'm just wondering whether there needs to be a reflection on opportunities that there are to have more of that early intervention for carers using the sum of cash, so not just local authority cash but the whole gambo of cash that now comes on the table from health and social care integration to do some of that work. Even some brief comments on that to get it on the record would be helpful and whether or not there has to be a cognisance of that, whether within this bill or within maybe regulations that follow from it in terms of best practice in promoting some of that. It's always good to support innovation, it's always good to support early intervention, it's always good to support anticipatory care, all these sorts of things. The challenge is that it always gets sucked up into crisis and the people that are deemed as most in need. I think that that's a dilemma in all sorts of areas certainly in healthcare. I think that the change funds have been useful but some have been more useful than others, we've been more successful with some than others and as the chair hinted upon my colleague has just said a crisis comes along and when you're trying to disinvest from something to put it into what the change fund has shown to be successful that can be particularly difficult to do. Should we nevertheless do it, should we be doing more in the way of prevention? Absolutely. I couldn't agree more in terms of the point about harnessing a wider range of services and using the opportunities that are afforded to us through integration. I think that we also need to remember that there is a lot that can still be done in terms of smarter use of resources. We know that there are challenges around eligibility and finite resources and I think that something that we were keen to see was a greater consideration of self-directed support approaches within a health context. That idea that someone who is in receipt of services under integration should not have a situation where their needs are still having to be categorised into this as a social care need and you can have flexibility through self-directed support options but this has been provided for a healthcare need and SDS does not apply. I think that at the time of the self-directed support act going through Parliament, COSLA has made a case for that duty and it has also been extended to the NHS. It was not, but that does not mean that there is no further work that could be done through guidance and through future bits of legislation that could harness some of those opportunities. One of the things that we have learned and that underpins self-directed support is that sometimes you can have a very expensive service that a carer is accessing that is not actually the best way to meet their needs. You can give them a personal budget and that individual carer will be able to have outcomes met in a far more innovative way than we have previously been able to manage. Just in terms of using the change fund and the integrated care fund to provide preventative services, I think that there are lots and lots of examples. We have set up dementia cafes and carers workers in the hospital to help to support that part of the discharge. More recently, we have used developed carer support workers to be part of an integrated care team, particularly to identify people earlier before they are in crisis. We can put in respite, we can put in replacement care before they basically end up in crisis because it sees crisis breakdowns that are costing us huge amounts of money. I will not follow up on the self-directed support issue at a local level within Glasgow. It has not worked well at all and I will not indulge myself by telling you why I do not think that it has worked well in the slightest. It has withdrawn choice from a lot of vulnerable people that I represent. However, I suppose that I just wanted to see if there was an opportunity for the carers bill to focus the mind of the new integration boards more than it otherwise might in terms of using some of those wider monies to support carers to do some of that preventative work. You do not have to come back on that subject yourself, but that was the reason for asking the question. I would just support that. It was quite disappointing seeing something that was mostly targeted duty under local authority, just as we are in to the discussions and the work around developing strategic plans and locality plans. I am pleased that carers are there in Dumfries and Galloway. They are being considered, but it would be really good to see that beefed up a bit more in the legislation. Dennis, will you help me out this time and pick up on the questions that you have been pursuing, Gertrack and young carers? Yes. Basically, I just wanted to go down the route of the possibility of setting out the duty for the appropriate assessments. Do you believe that the current legislation in the framework is adequate, or do you think that we need to improve it in terms of our young carers? In terms of young carers, our approach has always been to say that they need to be treated as children and young people first and carers second. It is very important that young carers have the same rights to having their outcomes met as do other children and young people. In terms of what is set out within the bill, we have a concern about fit with getting it right for every child and with the outcomes approach in there. Our concern is that by having a separate young carers statement, we will have a situation in which a young person has two parallel plans and that that will have an impact on holistic planning and co-ordination of support. Everything that is getting it right for every child is trying to achieve. There is a risk that young carers are almost siloed, if you like, and there is a subset of needs that is being treated differently. If it is decided to proceed with a young carers statement that someone also has a child's plan, that should be part of the child's plan. We shouldn't be going down the road of separate plans for subsets of needs. It also begs the question that, if you are having a separate plan for young carers, why not a separate plan for young people with disabilities or young people from black minority ethnic communities, it is running counter to the whole policy direction, which is about focusing on outcomes for children and young people and making sure that those are met irrespective of the needs that give rise to them. That is where it is. Is it important to think about the transition from being a young carer to an adult carer? I suppose the transition points are always tricky. They are an opportunity, but just considering when they go from being a child under GoFec and thinking how does that transition process work, I think, is important. Any drawing on that, certainly some of the feedback that I have had from carers centres has been the value of that young carers statement moving into that person becoming a young adult carer, although I have also had feedback that the terminology of statement feels a bit official and linked to the fact that you make a police statement and things like that, where the GoFec plan is less controversial, maybe. Dennis, do you want to respond to the comments? Having the statement there does it not then highlight the fact that you have maybe a lead or a key worker. You can achieve that through GoFec in itself, but having that statement does enable a process that maybe is not currently there. I think that it maybe does help with the transition period. Do you not agree with that? I think that the key point that was made is that it is not currently there. Our concern is that we have a major new piece of legislation, the Children and Young People's Bill, which will come into force in just August next year, that will require that there is a named person for every child and that there is a clear focus on ensuring that they are safe, healthy and active, and the rest of the scenario outcomes. That would lead us to question why do you really need that separate bit of legislation that is coming in just before something that will cover it and runs the risk of confusing the situation and making co-ordinated planning for young people that is actually more difficult? That is a substantive question. Just on the named person and the children's plan and statement and how they interact, some of the evidence that we received was that there was a reluctance on the part of young carers to have the statement shared with their named person, because, especially if they were looking after someone, for instance, with drug and alcohol problems, they were not very clear that they wanted that to be known by the head teacher in their school depending on how sympathetic that person might have been to that issue. I am wondering how things that a young carer would want to be dealt with as confidential would be dealt with, and is there the ability to have services set up to support somebody, to highlight to the named person that that person was indeed a young carer? That is really important, especially in a school setting, that adjustments are made to allow them to benefit from education, but some of the more personal aspects of their caring role, not to be included in that or not to be passed on? The key thing about the child or the young person being in control of what information is shared with whom, and I am sure that people who have given evidence in the next session will be able to go into how all of that plays out within the children and young people's bill. I suppose that the quick answer to that is irrespective of whether you have a separate young carer's statement or not. The named person approach and the child's plan approach and how information is shared among all the different professionals involved in that should be predicated upon involving the child or young person in deciding what information is shared with whom. My other question was about information and advice services. I have spoken to groups of carers, and some of those services have been set up in an ad hoc way by people who have been carers and may be seen a lack of information and advice for carers in their communities. There are a number of organisations in the third sector that provide that. There was a concern that the bill for placing a duty on local authorities would mean that local authorities would bring that all in house, and some of that really good local knowledge would be lost. I suppose that I am looking for a bit of comfort for those organisations. My own feeling is that if those services are out there, it would be for the local authorities to support them and, indeed, to develop them to make sure that they provided the services that are required in the bill. Perhaps you could give me some thoughts on that. Just in relation to Parthgan Ross, locally, when we have consulted with carers, its information advice comes up again and again. In terms of your question, our response is that we are going to commission information from the independent sector while we already have an information advice service. We do not see that necessarily as a line within the local authority only. In order that we have other independent sector services that are doing that, we are going to commission a special service just to make sure that we are providing that so that it would not be a local authority service, but it would be in partnership. I would say that I am trying to ensure that carers get the right information and advice at the right time is a real challenge. Certainly, we too commission from the third sector to the delivery of that, but we are finding also that through the carerware training that third independent and statutory sectors are delivering. In fact, we are starting to deliver it to hairdressers and people like that, trying to get everybody aware of where they can signpost people to. However, I think that it will always be an on-going challenge, unfortunately. We find that, particularly in a rural area, people can be caring for a long time before they even find out that there is a simple service like that. That is where the adult support plans are going to come in, I hope, and help benefit carers in that way. David, on the third sector, who knows what they are talking about, let us make use of them. I have a very good evidence that there are lots of carers out there who do not realise that they are carers or do not realise what services they are. I mentioned the information advice service, but I do not think that that is not enough in terms of what we need to do. There is also an issue about people who are declining carers assessments. We have about 625 carers a year who are declining carers assessments when there is an assessment of their client. Why is that? Partly, it may well be around information and training for social workers, but it is not enough to provide an information advice service. We need to do a lot more among our workforce and among the public to raise awareness about carers issues. Alison? There is so much information and advice out there already. It is not about reinventing the wheel. Whoever is provided, whether it is NHS 24, NHS Inform or whatever, as well as all the local services and signposting, it is either gathering it up into one central place so that people know where to find that information and being signposted. The information is out there, it is just that people do not know where to look for it, or as you say, do not realise that they are a carer and therefore that there is information and support that would make a difference to them as a carer. Just following up on that, excuse me Alison, but the national health service role, what part do you play in identifying the national health service? You are here for the national health service. There are obviously critical points that this committee hears about lots of things, such as discharge policy, unplanned going into hospitals and identifying of carers at that point. Does that happen? Should it happen? What responsibility should the national health service have for identifying carers and informing them at that point? I think that the health service has got a huge responsibility and I think that we have touched on it a little bit already. It is a hugely complex issue and some of it is around staff awareness about ensuring that people make the most of opportunistic moments to identify carers because people often do not realise that they are a carer. I was just to draw your attention to some research that was done with primary care and carers of people at the end of life or advanced illness. That is a group of carers that you would think would be easy to identify and that people would think that they were carers. In a relatively small study that was done here in Edinburgh, there were three main barriers to identifying carers. That was one that is often a gradual process and that is probably true for lots of things, whether it is a lung cancer or a dementia or whatever. There are not that many situations, probably something like a stroke, where you are catapulted into a caring role. Often, it is a gradual process and people appreciate that they are a carer until they are quite far down the line. Often, as someone's condition deteriorates, that becomes so engulfing that the carer can no longer separate out their needs as a carer and look after the cared for person. I think that there is also something about the legitimacy. I think there is ambiguity about the legitimacy of carers' needs in a carer's mind, but also in professionals' minds. GP's and hospital staff often think that their focus has to be on the care recipient. There is lots of work done in Lothian and I know in other board areas around staff awareness training and things. I think sometimes we are so focused and carers themselves are focused on the cared for person that there is a need to be very explicit about the legitimacy of carers' needs. We can talk about being engulfed by, if we open up to make it a universal right or whatever, I think there is an assumption that huge numbers of carers are going to self-identify. I think certainly this fairly small study showed that the vast majority of people that were identified from this study did not self-identify. It was by opportunistic conversations with a range of people in the practice, whether it was reception staff, GP, nurses or whatever. I think people are often quite hesitant about self-identifying themselves as carers and there is a lot of work to be done around staff awareness and a confidence. I think sometimes people don't ask whether they are anxious about opening up a Pandora's box of needs and of service demand that cannot be met. I think that is not the case. Often it is just a recognition and a validation of what they are doing rather than large service inputs. The local authority has the big responsibility for all of this in the national health service, to fulfil that responsibility when they provoke you. For instance, anecdotal stuff has personally been involved in the situation where emergency service would call for a arrived. If I hadn't been there that day, that relative would have been in the hospital but the presence of a carer reassurance or whatever prevented a hospital admission because a precautionary default position was that that 88-year-old person would have been in the hospital that day as a result of a fall in the house. The role of carers in that notification about admission to the hospital, discharge of hospital and that role and whether we are working effectively on whether the bill would encourage the wider question for this morning. I think that in the past we have been particularly poor at joined up working. I think that health and social care integration has been absolutely the right thing to do. I think that it was five pilots which I have been running for about seven years now in my own neck of the woods in Ayrshire. We are up and running with the health and social care partnerships and the rest of Scotland is coming along with it. That will go an awful long way to address a lot of those. Should there be attention paid to the role of carers in that health and social care integration? Absolutely. Carers do play a vital role in that. It has been indicated earlier in the mountain money that is actually saved within the public sector because of the role of carers. I think that it has been recognised and they deserve to get our support and return for that. I was just wanting to come in on the back of what Alison said again around the fact that we find that many carers might be told about the support that they can get and the information and advice on where to access it. Often it is when they are told by another carer that they move forward on it or by another professional such as a GP or a primary care worker. We tend to forget the influence of those people in getting people motivated to lift the phone and make that initial contact. If you are in the middle of being the complexities of life generally and the caring responsibilities that are on top of that, then something as simple as lifting that phone can be really challenging and finding the time to do that. I just want to say that I hope that that is why integration needs to have a far greater role in the bill in order to bring all of those things together. In terms locally of what the health service provides to support for carers, particularly through the change fund, we had health check workers for carers and we had a carer support worker, as previously mentioned, based in our hospital that really did fantastic preventative work and is doing preventative work. It would be good if it was more of a health, I think, from our point of view, health presence in the bill, but it does seem very purely focused on the local authority, almost purely focused on the local authority, and I think that jar has been mentioned with the integration agenda. Peining? Just to come back on that, because we too, under the change fund, offered carers across the region a health and wellbeing check followed by some kind of mentoring support if issues were identified that they needed extra supporting, like losing weight or stopping smoking and some of those other things that would help their health and wellbeing. Unfortunately, that came to an end when the funding ran out from the change fund. I would see that as a role of primary care, because those carers will also be patients of GPs. That could have been picked up through primary care, but we failed in Dumfries and Galloway anyway to get that followed through at the moment. It was maybe just to flip that on its head for a second, so rather than asking what we would have liked to see the bill saying in terms of duties on health boards or direction to health, to think for a moment around integration authorities and our ambitions for how they are going to result in more flexible services, better integrated services, ambitions around locality planning and being able to deliver greater involvement for communities in terms of how services are shaped at their local level. If you look at the causal response that has outlined some key concerns about where we think the bill is too prescriptive and too restrictive, although the duties are placed on local authorities, they will very much be devolved services, so we would have those concerns on behalf of health as an integration partner as well, if you like. It was maybe just to flip that on its head and say that we would see integration authorities as being the way to drive forward improvements for carers and all the bits in our response where we have outlined concerns about too much prescription on processes and inputs and not enough focus on outcomes that would apply for health too. Questions for members? Yes, Dennis. The view of yourselves in terms of there is a proposal to have a duty for information advice service rather than just establishing it. If the information advice service is there, do you believe that that would provide the opportunities for carers and other people, obviously, to take up what is there in terms of resources? So, just whether or not it should be a duty to establish information advice or not? Can we widen that because Dennis mentioned that? I mean, I think there's some discussion on that just earlier about advice, but I mean, I think resources, I think also, Dennis, is the capacity issues that the responsibilities would have on the bill and what, you know, what, what, you know, I think we've mentioned, we've been through the money thing. We will argue with Westminster we don't got enough, you will argue that you don't got enough from Scottish Government and that will, that negotiation will take place somewhere else, not necessarily in this committee, but the capacity issues and the requirements of the bill about what expectation we're giving out there and whether we'll be able to deliver that expectation as Dennis has alluded to in terms of, you know, good and independent access to advice or indeed the assessments that would need to be carried out or the increased people that we've been through, you know, what, what, what sort of calculations have we made about those capacity issues and whether the ambition of this bill will be delivered? The outcomes, how will it make a difference to individuals? Yes, Beth? I think in thinking about information and advice local authorities already have duties around information and advice under the self-directed support act and those apply to carers too. So, whilst we recognise that we need to get better, there's room for improvement in terms of information and advice, we're just not sure that additional duties within this bill are needed to layer upon on top of the self-directed support duties. I think in terms of what will make things better, yes, it's greater investment in information and advice and it's making sure that it's accessible for a whole range of groups. So, I suppose we were surprised to see additional duties on information and advice within the bill for those reasons. Anyone else? Paul? Just, I mean, it's already within the national carers strategy around information and advice and, as I mentioned earlier, that's locally, that's one thing that carers again and again tell us that they want is why we've commissioned one because they say, we just want one telephone number, one sort of website to go to, one where we can get information. So, I guess we feel it's, in terms of our strategic objectives, it's already there and in terms of meeting the preventative need that we have to, we think it's essential anyway. So, I mean, it's part of our current plans, but I'm not sure whether it needs to be a duty or not because it is or contained in other, is a strategic objective already? As we don't, the places we have it is working well because you've got maybe a hub, a one-stop shop for people in other areas don't have that facility. So, basically, you know, when we come back to the sort of national aspect or creating a duty, I'm just saying that Paul's identified good practice, but that good practice maybe is not being replicated in other areas. Perhaps you've got a bias sample here, because I suppose most areas would see it because it is something that comes up so, so regularly around, you know, from carers information and advice. However, as I said earlier, the information and advice might be out there, but people don't always find it. Is there any other questions from my committee? I thank the panel for the retentancy this morning, sorry about the delay in starting. We have, obviously, very good written evidence from you, which is clear and inside from your point of view, and will assist us in our deliberations. Thank you very much for being with us this morning. Thank you. Suspend at this point while we change the panel. We reconvene, I presume, our business continuation of agenda item number three, evidence-taking, and we now move to our second panel of witnesses. Giving evidence on the Care of Scotland bill today, welcome to you all, Tricia Hall, social work managers, Scottish Association of Social Work, welcome. David Fornston, convener, community care standing committee, social work Scotland. Fred Beckett, north-east social work carer team, manager of Glasgow City Council, social work services, and Tarn Bailey, Scottish commissioner for children and young people. Welcome to you all. I'll just wait a second until Nick hits his seat, and then we'll move directly to questions, if that's okay, with our first question coming from Rhoda Grant. Thank you, convener. The bill talks about young carers and removing the caring role from children, preschool children. Do you think that that's the right approach? Is it possible to do that? Should it be for children in school as well as preschool? Oh, right, okay. Absolutely, I think, for children who are under school age, we have to approach this from their children first and their carers second. I think that, especially in the very young children, there shouldn't be any acceptance of that being in a caring role. It may be that they can make a contribution, but I really don't think that that's feasible, and even for children above that age, I think that we have to strike a balance always between the capacity of the child and the expectations on their caring role. It's not to say that caring is always burdensome because children will sometimes thrive in those situations, that sense of responsibility, but we have to make sure that they have a childhood. Most often, the children who are young carers, one of their complaints is that they don't get recognition, and as a result of that, they don't actually receive the support and weaken witness. Many occasions where children are quite literally being deprived of a childhood because of overbearing caring responsibilities. If the act does anything, it will help to redress that kind of balance, which, too often, I think, is stacked on the expectation of the child. I would agree. I think that, particularly for young children, it risks formalising the caring role and almost places a formal responsibility on their child for the parent. That may be something that an older carer is able or willing to take on, but I think that, particularly where there may be protection issues and there's a conflict there, the younger child, I think that that would not be desirable. I agree. It's not acceptable for children to be working the law. It's actually really clear that children under the age of 13 are not allowed to work if they're talking about private enterprise or anything like that, so we shouldn't accept it in any other way either. By the same talk, it is about being sympathetic to assessing what is needed and doing that in a way so that a child who may be deemed in need doesn't become a child at risk. We're really, really clear about the support systems that we're putting in there. Hopefully, the bill opens up the fact that people may seek support where previously they may have been wary about doing so, because otherwise, they might have an assessment that will end up with their child being taken away, which I think that the message has to be very clear that that is not going to be the case, that we are trying very hard to put in mechanisms to support so that that child can have a childhood. In agreement with that, a child under preschool, under school age, taking on a care and role, it's not a very good indictment in our society and we should be doing everything we can to alleviate that care and role given my childhood. Rwyda. You'd have heard comments from the group before about the carers' statement on the child's plan and concerns that we had, certainly from representatives of young carers' groups, about confidentiality. Indeed, the child's willingness to have their carers' statement shared with their named person, who, for various reasons, might have concerns about knowing that, where do you think that that line should be drawn, come the two things, interact, is there a need for two things, should there be one thing, how best to support young carers? I think that that's about developing a relationship, being really, really clear that information that is shared, hopefully is shared with the consent of the young carer and should only be shared if that is not the case, if it is deemed that that young person may be at risk. I think that there are very clear guidelines in our legislation for that. Clearly, there will be a need for a use of both plans where a child does not have a child's plan and therefore is primarily a young carer. I think that where there is that overlap, where the child is thought to be in need or at risk, then I think that we would be concerned about the parallel plans. I think that the point was made earlier about confidentiality, and I think that keeping the child at the centre and consulting the child would be really important. Clearly, there would be occasions where there would be a need to share information if there were issues, for example around a parent with drug and alcohol issues. That was being kept by one social worker or as part of a carer's plan, but it was not known to the name person or the lead professional under goffick arrangements. That could certainly carry risks. I think that that would be about sharing with the child the need to breach confidentiality and make sure that information is known to the name person and other people who have a responsibility for protecting that child, which should be paramount. That is tricky, because we have just got new legislation that is about to be enacted with name person being central to that. As I understand the bill, it will highlight the issue for young carers through the young carers statement. The whole purpose of the Children and Young People's Act was to go down the route of having a single plan. I think that it is fine for those children where there is a children's plan. You can include the young carers statement as part of that, but there is a much bigger group of children where there will be a young carers statement. I am quizzical about where that would sit in terms of the overall legislative landscape. The second thing is that you have asked a really tough question in terms of the information sharing. Again, that goes back to the Children and Young People's Act, because the information sharing section on that and even the guidance gives rather a light touch to information that should and shouldn't be shared. Practice will be developed on that. The reason that it gives us a light touch is because so much of that is down to judgment and the judgment of the people who are holding the information or expected, rather under a duty, to pass on the information on the basis of wellbeing. I checked the latest consultation and guidance for the parts of the act that contain the in-person and child's plan. There are only two mentions of young carers. Both are examples. In fact, in the section on the guidance on the child's plan, there is no mention of young carers. In fact, I think that this whole process may highlight a gap in the considerations that would go into a child's plan, so it is not just for this piece of legislation. In fact, it is for the Children and Young People's Act of which we are just about to enact. I am absolutely behind shining a clearer or a brighter light on young carers, but because of the all-compassing nature of the Children and Young People's Act, we have to think carefully about how future legislation maps on to that particular landscape, of which we are just at the start of just now. I think that there are a lot of things to be sorted in relation to the name person, and I am a supporter of it. However, it presents challenges when we have a desire, as the bill has, to have a specific focus on a group of children with specific needs, such as young carers. Just looking at how we implement that in practice, what we are looking at in Glasgow is working hand-in-hand with education around them having a child's plan, and what we currently have as a young carers assessment will match the generic indicator so that we are building on that in relation to the care and role. Currently, we are just looking to share that with the named person, whether they come into us first or whether they come through. We have not got on to the way to have issues around confidentiality and how we support young people in the time of child protection. We are concerned that it is duplication. We think that we should be absolutely working hand-in-hand with Gyrffyx the way ahead. We should be working with schools and schools in an ideal place to identify young carers. We have not got to the menu to how we can jointly share those information and be guided on that. However, clearly the direction of travel is to work hand-in-hand in education based around the child's plan. Any further considerations on the reflections of the children's commission that are from the witnesses? Dennis Robertson? Just to pursue it a wee bit, we are obviously looking at the integration with the education, the integration with the CAMHS service. Do you feel that, obviously, because we are looking towards a local authority and health board integration with young children who have maybe been identified to CAMHS because of issues around caring or whatever? Do you think that the bill in any way through the young carer statement would help those children with the CAMHS service? I would go wider than just CAMHS services. Essentially, any adult services—in particular, drug, alcohol, substance misuse services, mental health services, disability services—any services that are dealing with adults and that are children involved, are issues that we would want those adult services to consider the needs of children? Most often, that has come up in terms of tragedies where there have been child protection issues, but in this particular instance, the other question is, and do those young children—those children—are they taking on any caring responsibilities? Is that proportionate for their age and maturity, or should we be making sure that those children get the necessary support? The identification issue is principally through schools, GPs and health services, but those special services that are dealing with some of our most vulnerable families may well become aware of children living in those situations who are in need of some protective measures or who may well be in need of some additional support as they are identified as being young carers in those sometimes quite difficult situations. What the bill will do is to help to tune people to ask in that question, is this child, assuming caring responsibilities, is that appropriate? What support should be put into that family, not just in terms of the basis of the adult who is requiring support, but also to consider the needs and best interests of the child that is living in that situation? To that extent, I think that it will help, because it will make people much more aware of what we think are huge numbers of children who are just not being identified right now. I have to say that I really struggle to get feedback from members of our association on this bill and some of the reasons given where maybe it was because there has been so much new legislation this year in mental health, children and young people act, SDS, public bodies, et cetera, et cetera. However, one of the examples that stood out for me—in fact, there were three of our members that raised scenarios whereby the police were actually the referring agency that recognised that there was a young person in a household that was doing things that really, in this particular police officer's opinion, should not be doing. As I said, there were three different examples of different police forces that identified something needed to be done there. The strap line was that it's common sense to see that. How common sense then relates, obviously, into support mechanisms is another kind of debate. However, I do think that there is more recognition of that than maybe there has been in previous years. Really, just to echo Tam's point, I think that, with integration, there will be a number of authorities, including my own, where children and adult services will be separated, there will be essentially two different organisations. The inclusion of a young carers statement and, conversely, an adult statement should focus the minds of social workers, whether they're working in children's teams or adult teams, coming across children who are in caring responsibilities or adults in a household if they're working with children. I would certainly see that as a benefit of the bill. Yes, Fred. I think that, in practice, the bill has a significant opportunity for the future, because we, across Glasgow, might have identified 300-node young carers last year, GP referrals, and sometimes predominantly the firefighting, but we don't see the most vulnerable children, the ones living with mental health, the ones living with addiction, and they're the ones going to school. If the children's bill on this gives us an opportunity to pick up them in the old preventative anticipatory before the firefighting gentlemen is absolutely right, the CAMHS team, by the time we get there, these are very damaged and vulnerable children. That is the biggest opportunity that we've had, to get into schools. The key agency in a child's socialisation is to look at them holistically and make a difference in their lives. We need to get this one right, or 10 years from now. We'll still be in social work traditionally firefighting, but we know who these children are. They're vulnerable. We have a huge opportunity to get education on board and work in a preventative anticipatory way to support the children for the future. Richard, do you want to add that to the bill? I want to add that to Mr Becket's point about the parents who have addiction problems. Have any of you been consulted about DAISY? Do you even know about DAISY? It's the current working group that is examining the new data collection system for drug and alcohol addiction. I tried to design one in 2007 and it's never been followed through, but it was one where the children and the children's needs would be looked at in the addiction services and that could be then transmitted properly. Do you want that, Richard? No, I'm not. I'm a politician and I had to come off the whole thing. They subsequently found a way to abandon the programme that I had got to the point of a piece of software in 2007. The powers that be decided that once I was out of the way they wouldn't continue it. Here we are eight years later, still without a collective data collection system. The committee could justfully write to DAISY to say that the issue of data collection has come up and there's an opportunity to at least flag it up as part of the consideration. If you feel that would be useful. It's worth waiting to give your evidence and a great double act to it. Can we get responses from some of the other panel members on that? In my previous life, I worked for Aberlour child care trust and we did start a realist evaluation study of work with a lot of substance abuse services whereby we used the wellbeing indicators for the adults as well as for the children involved and then started following over years. Sadly, the usual story is not enough funding etc. However, I think that it's something that the committee maybe would want to look at in terms of longer term outcome measures and actually measuring whether or not these outcomes are being achieved because I think we're very process driven. We keep coming up with new ideas and with new systems but it would be really helpful if we also put in some of the measurements and some of the ways of actually being able to state at the end of a period has this actually made a difference. What is our evidence? What is the impact as a result of that? Another thing that members often have come back to me about is what really works for them is hearing about areas where things are working. The Highlands Health and Social Care Integration is going to be a bit faster because obviously they were a pathfinder. Our members there have had more success and maybe also with some additional funding than maybe in some other areas and other people have found it very useful to hear what it was that actually worked there. Again, not just measurement but also sharing what works and doing that in a way getting people together and not another website because nobody's got time to read them any more. I'm looking at that as well. Anyone else? David? I'm certainly carers or however they define themselves of people who are drug and alcohol problems or its parents or spouses. Other family members are, I think that we'd agree, a hidden care group that are less likely to receive formal community care services, you know, home calps or daycare or whatever. They may have occasional residential rehab admissions but on the whole they're less known to social work departments and others so there's a need to raise their profile. Just on, I'm hesitating to get back to this process and stuff because I think we do agree with the committee, we need to identify best practice and focus on outcomes and, you know, how prevention can delay all that but processes, we need to go back to the earlier session and there was, you know, quite heated in and around the whole question of identifying and supporting those carers who are not currently identified properly or supported at this point. There's a capacity issue in terms of, you know, in and around those adult assessments and children and the earlier question was asking about the capacity and the current capacity. How will, we know, anticipates that that will identify people, barely help people, maybe prevent stuff happening but given the pressure within the system what is the capacity for social work in particular to be identifying these groups who may be a lower priority than currently is being addressed at this point. So what does that do to the capacity? What will that do to the outcomes indeed for those at a higher level who will see some of that capacity drift away from them? Tom, I just want to answer the question about identification because I think my colleagues could answer the one about capacity. I have had the privilege of attending the young carers festival for the last five years. The messages are quite mixed from young carers. On the one hand, they want relevant people such as teachers to know about it so that they can be sympathetic and give some flexibility in terms of the expectations of them, in terms of homework production or maybe the time that they come into school. On the other hand, some young people say that this is my family's business and I do not want people to know about it. It is actually quite difficult to get the right balance because I would always advocate listening to the views of children and young people but in this instance they are quite mixed in terms of what they would want to happen. I think that we should err on the side of asking the question of the young person so that we at least know who those young people are. All of the figures that are given are rephrased. There is some doubt as to what the actual numbers are of the number of young carers that we have. I think that we will not know until we start to more systematically ask young people about their caring responsibilities. That goes back to awareness of those who are working with them. It is about your schools, your GPs, your specialist workers who are dealing with the adults in those instances. It is through that that we will get a better idea of the numbers. If you share that resource with the front line, the house is burning down. If you leave the house, it is burning down and you will go and take assessments with people of a less priority given the resources. The universal services should be able to do that. I am just asking the practitioner's task. I have a Glasgow perspective on it's all throughout. It is not a new challenge for us. In 2009, we were inspected by the then SWEA, and we had only done 86 carers assessments. Their recommendation was that we must offer all carers an assessment. We had to get our house in order. Just to put our services in context, we are social work in a partnership. We have primary care, acute care, social work in a third sector carer centres. Can we look at this as what we have learned over the time is that you look at the carers agenda in isolation, and you need to put it in context, is that a carer only becomes a carer when somebody gets diagnosed with a long-term condition. Ten years ago, we were looking for carers in Tesco car park. Now we go to the GPs and they acute the hospitals and we identify people by design rather than accident. We launched in 2011 a carers partnership and we had the challenges of capacity. If I look at it, last year, we identified 3,200 new carers. We did not identify the 10,000 or tens of thousands that we would expect and the 76,000 figures that are quoted. We started to identify people earlier in GPs closer to diagnosis and preventing people from getting into crisis situations. 470 of our referrals last year came from primary care and 105 from acute care. 72 per cent of our referrals came as we have an eligibility red amber green that came in early. It prevented of so. In terms of the challenges of how we respond to the demand, which was described by a colleague in the voluntary sector as a dripping tap rather than the flooding, I would adhere to that. We responded to that demand by providing anticipated preventative services in creating a level of assessment that was level to a risk. We could not do everybody an eight-page comprehensive carers assessment, so we started screening assessments and delivering services in that way. I think that we have learned overwhelmingly that we got caught up in the processes. We trained the social worker. Are we providing that level of assessment? However, the outcomes that we are getting back from individuals who are accessing that service in a preventative way is that they are really happy with what they are getting. We need to continue with that. This is nothing new to us in terms of the challenges of delivering the services. That is on top of the traditional social role where people are doing assessments of carers as part of a single-shared assessment. We are not expecting to do all that, but that has helped us to rise to some of the challenges. We are hopefully not going to see the tens of thousands knocking on the door. I would also add to that that the point that was made previously about an integrated way of working with the NHS is that we need the NHS to tell us when they are diagnosed with somebody who is in a long-term condition as close as possible, when that bears in to help and support them in a preventative and anticipated way. When we get that right, we avoid people getting into crisis. We deliver better outcomes and it is less resource intensive. The old days are where people just turned up 10 years ago at the duty social work team in their hands and knees to be honest and we try to turn that around. We have better ways of delivering services than that. David. As an association representing senior social work managers, we would not be in favour of an unrestricted definition of carers and that is for the reasons that I am sure that have been covered already this morning. Firstly, the impact on practitioner time, the ability of practitioners carrying caseloads to be able to prioritise their work and deal with the people who are most in need and most at risk, would be prejudiced. Notwithstanding the extra funding that might accompany the bill, it is unlikely in this day and age that local authorities are going to be significantly increasing the size of teams. I think that there will be worry of creating new posts or permanent posts. It is likely that social work teams are going to remain about the same size. I think that it is really diverting or could divert social work time away from pressing matters towards albeit very important matters around carers. I suppose that the accompanying thing about a diversion of scarce resources, again if we are dealing with budgets that are currently anyway at a level or declining, that if we are talking about certainly diverting carers resources that are not necessarily for the cared for person but could be for the benefit of the carer without additional resources, that would be a second concern. Maybe a slightly more conceptual point, I suppose, some concern about the universalising of the caring role, potentially quite a shift from private to public in terms of the care role bringing carers into the social work net, whether there are other ways of dealing with that in terms of capacity building within the community and a much wider carers strategy, which I could go into later in more detail that it is not just about improving social care but a range of other measures that are going to help carers continue in their role. I think that people sometimes still go back to section 12 of the 1968 act, which places a duty to promote social welfare by making available advice, guidance and assistance on such a scale as may be appropriate for their area. That legislation has never been repealed, although there has been different variations in different new bills that have come to fruition. I think a lot of social workers would still really want to work as change agents, as community workers that work within the community and are a part of a hub. That is a cultured change that I think we still need to promote as much as we can. There is nothing as damaging as individual social workers doing detailed assessments, identifying need and then saying that we cannot do anything about it because we have not got the resources. There has to be that fine balance. If a need is identified, we also need to be confident that we can meet that need. The way that we meet that need goes a good example. There are other authorities that have really tried to have that conversation and to go more towards a public health model, to be more preventative, to enable that culture change and not just make it the duty of certain professionals to do the work that needs to be done but to make it something that actually resides within the community, where people within the community also have a role to play. In that context, it is very important to maintain some of the support mechanisms that are already there. Examples like a young carer that I knew used to go to the youth club. That was her time away, that really kept her going. The youth club is now closed because there was no money. I know that there are very, very simple examples but there are very important examples in this context. Can I just supplement here on that? David, you mentioned this wider support. I have gone back to Tam earlier as well about what people see, the role of the family, the family business, and the balance, I suppose, that I am trying to get at. Not just simply in a wider term, but in a community capacity. The family's capacity to care and how to support that has not been too intrusive that you can actually chase the carer away because you do not want to be there when the assessment shows that a carer should be there, so you do not want to clash with any of that. David? I absolutely agree. In case my comments were seen as negative, I think that there are a lot of positive aspects to the bill. My concern is just that carers are raised expectations, they are drawn, they come and ask for their support plan and that may or may not be the appropriate avenue for them. I appreciate that this committee is concentrating on the devolved powers around social care but supporting carers properly has to take in all kinds of tax and welfare benefits, access to further education, flexibility around employment, all matters, which I am sure you are aware of. A national carer's strategy needs to reflect all those things rather than, as was said, targeting it on a particular profession, whether it is social work or health or whatever, and saying that you will carry out those support plans. Is this what people are looking for as opposed to better supports coming community-wide? There will be occasions where a child is part of a range of supports that are in a wider family network and there may well be no need for additional support to whatever role that child is playing. There will be other occasions where, yes, there is a need for some additional supports, but whether that has to always come through social work, I would question. I think that there is a range of agencies that would potentially be involved with that family. There is quite a debate about the role of health services. There are voluntary sector organisations and there may be specialist organisations, so I do not necessarily see the burden of support falling just on social work. We should be using a range of organisations around a child to enable them to have the best family life that they can in whatever circumstances they are living. We are learning a lot about the needs of carers and I keep going back to the long-term conditions. We have had nurses in our teams for some time. We can predict which conditions people will be diagnosed with that will have a high-care burden, such as motor neurones, Parkinson's and MS. I think that there is a role to be played in there. I was a social worker. If you walk into health service and try to say, have you got any carers, you do not get very far. We recruited nurses and they walked in and we have a massive increase in primary care, getting people identified earlier. However, there is a role in there for the NHS Party. Your standards of contact are about identifying patients and supporting them in their carers. There is specialist information about managing conditions. We do not have to do it all in social work. There is a role there for the NHS that they are already doing, but perhaps it is not counted in how they look at their services. Equally, a lot of the people who come to us as part of the partnership work hand-in-hand with Alzheimer's Scotland, Chest Heart and Stroke. A lot of the information that carers want is about managing that condition. One of the biggest increases in demand in Glasgow is training. People want to be shown how to move with assist, how to manage conditions. The increase in that capacity does not all have to come to the local authority or carer specific. We need to work with condition specific services around the long-term conditions to your one self-supported care. We are not always coming with a ball and saying, give us more money. We need to have looked at how we provide that anticipatory support in a creative way across all the services out there and get them working together more effectively. Ideally, by doing that, we are delivering better outcomes for carers and the person that they support, but we are also shifting the balance of care in terms of reduced falls, hospital admissions, accident and emergency appointments, so it meets the strategic priorities as well as delivering on the better outcomes. Before we go into my substantive question, I will just mirror what Mr Formstone said in relation to the wider carer strategy irrespective of where powers or responsibilities sit. Some carers have told myself, for example, that carers allowance is £10 less a week than job seekers allowance and quite often it does not go claimed because there is clawback from other benefits and you get underlying into how much passports are on to other things. I just put that on the record to say, I think that we appreciate that it is more complex than just having young carer statements and adult carer plans. It is in relation to the young carer statements that I want my substantive questions to be on. The first one is just to get some brief information on the record. The bill says that when a young person reaches 18, if a support plan is not in place, the young carer statement should stay valid and on-going in terms of dealing with transitions. I am just wondering whether that is desirable, if there is any additional steer that you would give us as a committee of the Government on how to make sure that works effectively. Transitions is a difficult issue for a whole range of aspects of children's lives and, generally, we are very poor at the transition from children's services to adult services. It is a welcome consideration about how the young carer statement would somehow carry forward until such time as there is an adult carer statement, if that is the right terminology. You would need to put a time limit on that, but I think that it is worthy of some consideration as children move from child focus services to adult services. We have got exactly the same problem in additional support for learning, in terms of young people leaving care and even moving from education to employment. It is a really difficult time, so I welcome the consideration. It is a modest proposal that it continues, but that may help. However, you might want to think about how long it will continue and the expectation that there should be an adult statement in place before they are removed from whatever the statement was in terms of the young carer. David? It makes sense not to have a sudden cut-off at 18. One would assume that a young carer is caring for an adult. Therefore, if the adult is receiving services, those will be already in place provided through adult social work teams. That should not be a problem. The issue may be about meaningfully supporting the 18 or 19-year-old with their plan that may have happened previously with the named person or a children's social worker, moving into adult services with a much higher number of client service users. The issue might be about whether that young person could be intensively supported for any length of time. We are on new ground in 18. I am going to keep going to Glasgow. We have an integrated service, so we have adult workers working alongside young carers. The fundamental change is that when you hit 18, you should be alleviating your care and role up to the age of 18 and then supporting it in your care and role at 18+. Each circumstance is individual, so we need to have a look at that. However, where we have had young people who were detrimentally affected by their care and role, we have looked at things such as self-directed support for children with parents and the way that MSs are. It was not appropriate for them to be taken on moving with assistance or personal care and role. We have supported those children to get back to school and have a childhood. We need to have a look at that. If we have known a child from a young age as being a carer and we are hitting 18 or older and they are still detrimentally affected, we really need to be having a look at ourselves as in what we are doing with them up to the age of 18. It asks big questions, not just of social work, but of wider services and alleviating children. We are going to adopt an approach in the future. We will start it now. We are looking at a family-based approach. There have been ways of taking children out of households and providing services and then putting them back into the same environment. We think that we need to be looking at questions with the whole family if we need to move down the adult support protection or sometimes child protection. We have to do that, but we should be asking families, what are you doing to allow your child to have a future? Is there small changes that we can make further down the road that prevent us from hitting crisis points? There are a lot of services out there supporting young people in schools, careers, advice and what have you. Are you aware of the issues that young carers face? When you are looking at their future plans about college or education, do you just write that off? Are you a young carer? Do you look at how your named person finds out about that? Again, they are passing through the system, and they do not just get into crisis at 18. It is preventative anticipatory services. With what is already being said, it is helpful for there to be a formal point of recognition that there is just somebody or something that allows for the young carer to have additional input, because it may well be that somebody has quite a divided loyalty in terms of not wanting to say to themselves that I want to move out or that I want to have my own relationship and go somewhere else. There may be issues about attachment. There may be issues about being frightened. Maybe not themselves wanting to say that I want more help, but being able to use the fact that I have come to the end of my support statement, I am now going into something else. It allows for somebody else to come in to make that assessment again and to allow a bit more freedom. I think that all of that on the record will help our scrutiny and to pose some questions back to Government in relation to that. We have heard about anticipatory planning in terms of the emergency happening down the line. Can you mitigate that? The young carers that we met with as part of our evidence session in Glasgow were talking about, for example—I have to say that they were over 18, but they still defined themselves as young carers. They were young and in a caring role. I am not talking about the legalistic aspect of the bill, but, for example, going to college was their respite care. That was the respite break that they were getting, rather, was going to college getting on with their life. It is in how we tie in other agencies to future planning, which is not about mitigating the burden of care or anticipated planning for emergencies, but it is about future life planning. Whether there is a role there for wider public agencies such as colleges, universities, Skills Development Scotland in terms of awarding apprenticeships in schools, who is doing that job, where does that fit in? I am trying to paint a picture of a web of support to allow young people who happen to be carers to get on with their life as close to normality or their normality as possible, where they still have the same aspirations as everyone else. Sometimes the chat—not today—has been about, well, how do you support the young carer when there are significant burdens of care to get some respite in relation to that, but it is about the longer-term planning aspect, so that they are not held back in their own personal life as individuals because of the burden of care. Does the bill fit into any of that, or could you give us any pointers on how we could give a nod to some of that? That was the evidence that I got from the session that we had in Glasgow recently. You might want to look to the Children and Young People's Bill on how they approached corporate painting responsibilities. They had a very long list of public bodies who came under the schedule associated with that bit of the act, and they are now under the obligations of that particular section of the act. My office is part of the corporate painting responsibilities. People who read this will find it quite amusing, because we opposed that, but it took a very wide perspective on who are the agencies that are responsible for young people leaving care, and they included them as having duties under the act. If you have a list of relevant agencies, you might want to think about that. My advice would be to keep it to those that are absolutely relevant, but you have already mentioned some of them. If I can just widen it out to all carers, taking on Mr Doris's point to a minute, I think that transitions is the time when carers who are parents of young children, I think that it suddenly hits them. They have had full-time support from school, they have had a lot of support often from health services, suddenly the child leave school, maybe a special school or whatever, and the local authority is struggling to provide, if you like, a five-day replacement service through daycare and other activities. I think that is when carers, they may be in employment, they may then struggle to keep in work, and they come into us saying, if you do not give us that amount of support, I am going to have to give up my job, they may want to take on education, they may in fact be reconsidering the whole caring role and say, well, I have done this for 21 years, I would like some respite to this. I think that that touches on one of our concerns, I suppose, about the whole thing about outcomes as opposed to needs, which you may have rehearsed previously, but I suppose how we distinguish routine personal outcomes for the carer and outcomes to do with the caring role, and I think that that would certainly, if this legislation was couched in terms of aspirations and outcomes, I think that that is where we may struggle to distinguish what is a caring outcome, if you like, from wider outcomes. Thanks for that. Yes, Fred. Read it, sorry, read it. What you are saying again about the difficulties between looking at the carer in isolation and looking at the carer for person, but we need to get better at future planning, because a child just doesn't decide at 18, you're going to go to college or university, and if they decide further back down the road, there is an opportunity for conversations, we do overlap with SDS, we do look at telecare, assist of technology to allow people to have more freedom and more choices, but we need to get better at looking forward at these issues and planning for them. Final question today is from Dennis Roberts. Thank you very much, convener. I'm slightly concerned from David's remarks. I'm looking at empowering carers, being empowered as individuals to have lives of their own outwith that caring role. If I was taking up David's remarks, I think that you're saying that you're possibly concerned that you may not be able to facilitate the care, if the carer suddenly spreads their wings and goes off to either college, university, employ it, whatever, and leaves this vacuum, is that what you're saying? The resources may not be there to facilitate that. I would be absolutely for empowering that carer or person who no longer wants to be such a full-time carer to be allowed to do all these things absolutely, and we should be doing our part to facilitate that. I think it's the harsh reality of limited resources and the fact that increasingly social work departments, local authorities are struggling to fill in that a whole week of support to allow the person to carry on employment or enter education. But now it's certainly not something that we would be against. We would absolutely wish to empower carers as far as possible. No other questions. I thank the witnesses for being with us today. We've taken note of the evidence that you have given us. Thank you very much indeed. That concludes our business for today. See you again next week.